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THE NATION’S NEWSPAPER

Collegiate
Case
Study
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Lack of sleep sends


emotions off deep end 1-2 The Truth about Sleep:
Myths, Realities and Needs
Drowsy drivers: A wake-up
call 2-3 How much sleep do you need? The answer is simple: It depends. On you,
that is.
Extended sleep may give But the picture is becoming clearer every year about what happens when
athletes a boost 4 there is not enough. Sleep researchers are putting together a daunting pic-
ture of what happens to us mentally, physically and emotionally when we
Sleep habits affect weight, cheat ourselves of this basic need.
study finds 4 This case study explores some of the realities and effects of sleep deprivation
and provides tips for understanding your own sleep needs and how to keep
Sleep deprivation might lead yourself in top performance mode. Your future depends on it!
to Alzheimer’s disease 5

Late nights could catch up Cover Story


Lack of sleep sends
with you 6-7

Regular bedtime boosts chance


for success in school 8-9
emotions off deep end
By Sharon Jayson sleepy and less active,” says Mat-
Additional Resources 10-11
USA TODAY thew Walker, assistant professor
of psychology at Berkeley and a
You might have guessed it, but now former Harvard sleep researcher.
researchers have real proof: Sleep But Walker says the imaging study
deprivation causes our emotions to published in today’s issue of Cur-
go haywire. rent Biology found that the brain’s
emotional centers become “60%
That’s according to the first neu- more reactive.”
rological probe into the emotional
brain without sleep. It was carried The study also suggests that lack of
out by researchers at the University sleep elevates activity in the emo-
of California-Berkeley and Harvard tional centers of the brain most
Medical School. closely associated with psychiatric
disorders such as depression.
“Most people think that when
you’re sleep-deprived, what hap- Walker’s team studied 26 people
pens to the brain is that it becomes ages 18 to 30 who were divided into
Reprinted with permission. All rights reserved.
As seen in USA TODAY LIFE Section, Tuesday, October 23, 2007 Page 2D

two groups. The sleep-deprived group was awake 35 tions similar to psychiatric conditions.
hours; the other group slept normally.
Mary Carskadon, a professor of psychiatry and human
Using the brain scans, the researchers showed par- behavior at Brown University who has studied ado-
ticipants a series of images, from neutral to increas- lescents and sleep deprivation, says the new study is
ingly negative and disturbing. The responses of both compatible with her findings. She is particularly con-
groups showed up as hot spots, but the sleep-deprived cerned about what it means for adolescents, who are
evoked stronger responses because the prefrontal often sleep-deprived and who are being diagnosed
area of the brain that normally sends out inhibiting with depression in increasing numbers.
signals wasn’t able to keep emotions in check.
“What we don’t know is whether early sleep depriva-
Though the thinking has been that psychiatric disor- tion then projects out to things like major depressive
ders cause poor sleep, Walker says now he’s not so disorder or bipolar illness and whether we’re really
sure because those he studied didn’t have psychiatric setting up our kids for these major problems as they
conditions, yet they exhibited emotional brain reac- grow up,” she says.

As seen in USA TODAY NEWS Section, Thursday, April 2, 2009 Page 3A

Drowsy drivers: A wake-up call


Sleep deprivation carries risks similar to drunken driving’s

By Larry Copeland 100,000 crashes, resulting in 1,550 deaths and 40,000


USA TODAY injuries annually, according to the National Highway
Traffic Safety Administration. “That’s probably a con-
Lionel Edwards used to nod off while driving. For servative estimate,” says Jeff Michael, the NHTSA’s
years, he’d get behind the wheel and after five to 10 associate administrator for research and program de-
minutes find himself dozing. velopment.

“I was so exhausted because I wasn’t getting the Darrel Drobnich, chief program officer of the Nation-
proper sleep,” he says. “It was really, really bad, espe- al Sleep Foundation, puts the numbers much higher:
cially at night.” 71,000 injuries and more than 5,500 deaths a year.
“It’s a huge problem that’s largely gone unreported
Two years ago, Edwards, 39, was driving to his because we don’t have good, hard police data,” he
Pottstown, Pa., home after working a night shift. He says.
fell asleep, waking to the frantic honking of a wom-
an whose car he was forcing off the road. “She was An obstacle for police is that there is no test for
already on the shoulder,” Edwards says, adding that drowsy driving like the Breathalyzer an officer can
he pulled over just in time for the woman to avoid give a motorist suspected of drunken driving.
crashing into a ditch. “I told my wife, and she was re-
ally upset. She said I had to (get help).” A new battle

Drowsy driving is one of the most vexing problems Some sleep experts and state legislators say the na-
involving traffic safety. It is a factor in more than tion’s progress against drowsy driving is about where
Reprinted with permission. All rights reserved. Page 2
As seen in USA TODAY NEWS Section, Thursday, April 2, 2009 Page 3A

the campaign against drunken driving was 30 years Legislators in some states — spurred by the deaths
ago. That was before Mothers Against Drunk Driv- of constituents by drowsy drivers — are trying to
ing (MADD), before any stigma in getting behind the address the issue. New Jersey is the only state that
wheel after drinking, before every state adopted a criminalizes drowsy driving in a fatal crash by classi-
single standard for driving while intoxicated. fying it as recklessness under its vehicular homicide
statute. No state has a law dealing with non-fatal
“Years ago, we didn’t think anything of getting in a sleep-related crashes.
car after having a few drinks,” says Carol Ash, medi-
cal director of a sleep program at Somerset Medi- “The problem has been that people don’t take it all
cal Center in Somerville, N.J. “Sleep deprivation has that seriously,” says Massachusetts state Sen. Rich-
the same impact. Your judgment becomes impaired, ard Moore, a Democrat. He has been pursuing stiffer
whether you realize it or not. We’re starting to un- penalties since 2002, when a constituent was killed
derstand that drowsy driving is the same as driving by a driver who had fallen asleep and later admit-
intoxicated.” ted he had been up all night playing video games,
he says. “The penalty was a slap on the wrist, sus-
According to Ash and other researchers, a person pension of his driver’s license for a couple years and
who drives after 18 consecutive hours without sleep probation.”
performs at the same level as a person with a blood-
alcohol concentration of .08% — the legal standard Grateful for sound sleep
for drunken driving in all 50 states and the District
of Columbia. Edwards, now a night security counselor at a youth
center, was working the overnight shift at the Wal-
About 250,000 drivers fall asleep at the wheel daily, Mart in Boyertown, Pa., in 2007. He had just left
says Charles Czeisler, director of the Division of Sleep work when he had the near-accident that changed
Medicine at Harvard Medical School and chief of the his life.
Division of Sleep Medicine at Brigham and Women’s
Hospital in Boston. “There’s an epidemic of drowsy After his narrow escape and at the insistence of his
driving crashes, particularly among young drivers,” wife, Jamesha, he went to University Services Sleep
he says. Diagnostic and Treatment Centers in Pottstown. He
learned he has obstructive sleep apnea, a disorder in
In a national poll released last month by the National which a person’s sleep is repeatedly interrupted as
Sleep Foundation, 54% of adult drivers said they had muscles in the throat fail to keep the airway open.
driven while drowsy during the past year; 28% said Edwards was fitted with a mask that fits over the
they had actually fallen asleep while driving. nose and mouth and blows air into the airway to
keep it open during sleep. He sleeps soundly now
A widespread malady and says he’s thankful he didn’t kill anyone: “Yes, oh
my God, yes.”
About 40 million-50 million Americans suffer from
sleep disorders, but like Edwards was, about 85% of He was lucky: “The greatest predictor that you’re go-
them are undiagnosed. Yet they account for only a ing to have a sleep-related crash,” Czeisler says, “is
small percentage of drowsy drivers, who are more you just had a near-miss.”
likely to be young people and night-shift workers,
Czeisler and other experts say.

Reprinted with permission. All rights reserved. Page 3


As seen in USA TODAY SPORTS Section, Tuesday, July 14, 2009 Page 13B

Extended sleep may give athletes a boost


By Erin Thompson Cheri Mah, a researcher at the Stanford Sleep Disor-
USA TODAY ders Clinic and Research Laboratory and lead author
of the study, acknowledged that the athletes didn’t
Stanford University researchers have an idea that always hit the 10-hour mark. But they noticed a dif-
may be something to sleep on. ference even if sleep was extended by a half-hour,
she says: The athletes’ sprinting drills were faster,
If not enough sleep is bad, they wondered, could ex- their hitting was more accurate and deeper, and their
tended sleep be good? mood improved.

They had a hunch that getting more than the usual The study was part of a research abstract presented
amount would improve athletic performance and in Seattle last month at the annual meeting of the As-
mood -- a theory they say has not been explored by sociated Professional Sleep Societies.
exercise physiologists.
Frank Wyatt, president of the American Society of
The researchers asked five members of Stanford’s Exercise Physiologists, says the study is too small to
women’s tennis team to be their guinea pigs. After be definitive. But natural hormones are released into
following a normal sleeping pattern for a few weeks, the brain during sleep that aid in the physical recov-
the students, ages 18 to 21, were asked to sleep lon- ery process, he says.
ger; the goal was 10 hours a night.
“Serotonin and growth hormone are both released
The study was conducted during their regular tennis into the body while you sleep,” he says, “These en-
season; athletic performance and mood were mea- hance your mood and facilitate tissue repair, respec-
sured after every practice session. tively. So if you get extra sleep, you’re going to have a
better mood and have enhanced recovery.”

Sleep habits affect weight, study finds


By Michelle Healey People who sleep fewer than six hours a night — or more than
USA TODAY nine — are more likely to be obese, according to a government
Thursday, September 24, 2009 study out Wednesday that is one of the largest to show a link
between irregular sleep and obesity. The study also linked light
sleepers to higher smoking rates, less physical activity and more alcohol use. The research adds
weight to a stream of studies that have found obesity and other health problems in those who
don’t get proper sleep, says Ron Kramer, a Colorado physician and a spokesman for the American
Academy of Sleep Medicine. “The data is all coming together that short sleepers and long sleep-
ers don’t do so well,” Kramer said. The study is based on door-to-door surveys of 87,000 U.S.
adults by the National Center for Health Statistics, part of the Centers for Disease Control
and Prevention.

Reprinted with permission. All rights reserved. Page 4


As seen in the Gannett News Service on Thursday, September 24, 2009

Sleep deprivation might lead to Alzheimer’s disease


By RANDY DOTINGA through a continual measurement of their spinal fluid
Gannett News Service via a catheter — and mice. Their findings are reported
online Sept. 24 in Science.
If you’re middle-aged, you might want to try a little
harder to get a good night’s sleep, now that new re- The researchers discovered that the level of the pro-
search suggests the right amount of slumber might tein went up during waking hours and fell during
keep Alzheimer’s disease at bay. sleep. Holtzman said that its levels may be related to
brain activity, which is higher during waking hours.
The research was conducted in mice and is prelimi-
nary, and it may not apply to humans. Still, the pos- In mice, the researchers found that sleep deprivation
sible link between sleep deprivation and Alzheimer’s boosted the levels of the protein, which builds up in
raises the prospect of possible treatments that target plaques.
related pathways in the brain, explained study au-
thor Dr. David M. Holtzman, chairman of neurology If a person is awake for a long time, levels of the pro-
at Washington University School of Medicine in St. tein might build up, Holtzman said. This could play a
Louis. role in middle age because Alzheimer’s disease be-
gins to clog the brain several years before symptoms
“This might be a way to delay or prevent the disease become apparent.
by doing something in middle life” rather than wait-
ing until something goes wrong, Holtzman said. Dr. Nikolaos Scarmeas, an associate professor of neu-
rology at Columbia University Medical Center in New
The Alzheimer’s Association estimates that as many York City, said the findings are “very impressive, ex-
as 5.3 million people in the United States have the tremely valid and useful.”
disease, which is the country’s seventh-leading cause
of death. Alzheimer’s disease is incurable, and al- Researchers have linked sleep problems and Al-
though some treatments are available, they only re- zheimer’s disease before, he said, but from the per-
lieve symptoms. In some cases, those symptoms in- spective of the sleep problems being a symptom of
clude sleep problems. the illness and a result of aging. The idea that sleep
deprivation might cause Alzheimer’s deserves more
Holtzman and his colleagues were not initially look- attention, Scarmeas said.
ing at sleep, but instead wanted to better understand
how a protein clogs the brains of people with Al- Holtzman said that future research should investigate
zheimer’s. It’s not clear how these clogs, known as how processes in the brain can be manipulated with
plaques, and structures called “tangles” cause symp- drugs so that people get more sleep and less brain
toms. But experts think it may have something to do clogging.
with their disruption of how neurons communicate
with each other. For now, though, his advice is short and simple: “Get
enough sleep in middle age.”
The researchers developed a way to monitor the
levels of the protein by the hour in both humans —

Reprinted with permission. All rights reserved. Page 5


As seen in USA TODAY LIFE Section, Monday, November 26, 2007 Page 9D

Late nights could catch up with you


Researchers suspect that once sleep is lost, it may be gone forever
By Kathleen Fackelmann People who lose sleep because of a single all-nighter
USA TODAY typically make up for it by boosting the amount of
deep sleep they get the next night, says study co-au-
You’ve got a long list of e-mails to return, bills to pay thor Aaron Laposky, also from Northwestern. Deep
and, oh, yeah, you don’t want to miss the latest epi- sleep is thought to restore alertness and helps keep
sode of The Office. memory and other brain functions in top form.

By the time you crawl into bed, it’s nearly midnight. People also make up for the occasional bout of insom-
The alarm goes off at 6 the next morning, and bin- nia by sleeping in on weekends, Laposky says.
go! You’ve just joined the legions of Americans who
are bleary-eyed and flat-out tired most days of the But is that capacity lost when sleep deprivation be-
week. comes a fact of life?

For years, sleep researchers have been preaching the At Northwestern, researchers kept lab rats awake for
dangers of lost sleep: People who are fatigued can’t 20 hours and then let them sleep for four hours. After
pay attention to routine tasks, have trouble learning the first night, the rats recovered; when they were
and are prone to a laundry list of health problems, allowed to sleep, the rats fell into a deep sleep more
from depression to high blood pressure. frequently than they did when well-rested.

New research suggests an added risk to losing sleep But after three nights of sleep deprivation, the rats
day after day: Humans and animals that have chronic failed to show an increase in deep sleep. And at the
sleep deprivation might reach a point at which the end of the five-day study, the animals were given
very ability to catch up on lost sleep is damaged, says a chance to sleep in, but the rats recovered almost
professor Fred Turek, a sleep researcher at North- none of the lost sleep.
western University in Evanston, Ill.
“The ability to compensate for lost sleep is itself lost,
His research on sleep patterns in rats appeared this which is damaging mentally and physically,” Turek
summer in the Proceedings of the National Academy says.
of Sciences. That, together with findings from a hu-
man study, suggests people who lose sleep night after Sleep expert David Dinges says people seem to re-
night might not recover the alertness they need to spond to a chronic lack of sleep the same way.
perform well during the day.
Dinges, a researcher at the University of Pennsylvania
So far the studies don’t tell researchers whether the School of Medicine in Philadelphia, and his colleagues
damage is permanent. But they do suggest that peo- studied 48 healthy people. Some got eight hours of
ple who go to work fatigued day after day might per- sleep a night while others stayed up, losing from two
form consistently at a subpar level. to four hours of sleep a night.

“They may say, ‘Hey, I’m doing fine. I don’t need more By the end of two weeks, the people who had lost
sleep,’ even as their performance on memory and at- sleep at night said they no longer felt tired during the
tention tests goes down,” Turek says. day. But test scores revealed a different story, accord-
Reprinted with permission. All rights reserved. Page 6
As seen in USA TODAY LIFE Section, Monday, November 26, 2007 Page 9D

ing to the 2003 study published in the journal Sleep. lots of sleepy humans for a long time would answer
The sleep-deprived group had trouble paying atten- that question, Turek says.
tion, had slower reaction times and developed im-
pairments in memory, Dinges says. But even if the damage can be reversed, there’s plen-
ty of scientific evidence suggesting that sleep loss is
The ability to fend off sleep might have evolved to bad for your health.
help animals and humans survive a natural disaster.
People forced to evacuate during a fire or hurricane For example, fatigue might play a role in obesity. And
often lose sleep for a short period, but they’re more there’s no question that sleep loss plays a role in fatal-
likely to make it through a crisis alive, Turek says. ities on the highway. The National Sleep Foundation
says drowsy driving is the likely cause of more than
The trouble is humans have built a society that runs 100,000 car crashes each year in the USA.
round the clock, Turek says. Cellphones, laptops and
other electronic devices make it easy to stay con- For that reason alone, Dinges and other experts rec-
nected at all hours. All-night TV and an extended ommend getting seven to eight hours of sleep on
workday also can rob sleep, says James Walsh, execu- most nights. Losing just an hour night after night can
tive director of sleep medicine at St. Luke’s Hospital lead to foggy thinking and slow reaction times.
in St. Louis.
“The deficits can become severe,” Dinges says.
Surveys now show that most people in the USA get
less than seven hours of sleep a night, about an hour People who put off bedtime to get more done might
less than the average sleep time 40 years ago. find it’s wiser to make their sleep a priority. “You need
to make sure sleep time is protected,” he says.
No one really knows the full effect of the steady ero-
sion of sleep time. Only a study that keeps track of

Don’t lose that snooze


The American Academy of Sleep Medicine, the National Sleep Foundation and other sleep experts offer
these tips on getting a good night’s sleep:

• Do not stay up late to talk on the phone or surf the Internet.


• Keep computers and TVs out of the bedroom.
• Stick with a regular bedtime.
• Avoid food or drinks with caffeine, especially at night. Such stimulants can keep you awake.
• Don’t stay up all night to cram for a big work project or to finish homework if you’re in school.
• Avoid vigorous exercise within a few hours of bedtime.

Reprinted with permission. All rights reserved. Page 7


As seen in the Gannett News Service on Thursday, August 14, 2008

Late nights could catch up with you


By Darla Carter Also, Honaker notes, “We know that sleep depriva-
Gannett News Service tion can impair learning; it impairs mood, physical
health.”
Pencils. Check.
The National Sleep Foundation recommends 9 to 11
Paper. Check. hours of sleep a night for children 5 through 12 who
attend school, and 8.5 to 9.5 hours a night for adoles-
Folders. Check. cents.

A sleep schedule? Estimates among experts vary. “Elementary-age chil-


dren and young intermediate-age children probably
If that last item is missing from your child’s back-to- need 10 hours of (nightly) sleep, and then the adoles-
school list, then it’s time to write it in, some experts cents need at least nine, but that’s sort of a beginning
say. point,” says Dr. Vincent McCarthy, a physician and
associate professor with the University of Louisville’s
Children — and teens — not only need plenty of sleep, sleep center.
but a consistent sleep schedule that includes a regu-
lar bedtime, says Sarah Honaker of the University of Ease back into schedule
Louisville’s Pediatric Sleep Medicine Center.
To ensure that youths get enough sleep, parents
“I think it really improves the quality of life for the shouldn’t wait until the last minute to get them back
child and (may improve) the child’s mood ... and cer- on a school-year sleep schedule, Honaker says.
tainly that has important implications for ... the well-
being of the family in general,” says Honaker, a psy- “It’s important to return to the schedule gradually
chologist. because if you ask a child who’s been going to sleep
at 10 or 11 all summer all of a sudden to fall asleep at
Past surveys by the National Sleep Foundation, a non- 8, then chances are they’re not going to be able to fall
profit organization that educates the public on sleep asleep at that earlier time,” Honaker says.
and sleep disorders, have found that children often
don’t get enough sleep. She suggests having the children go to bed earlier and
earlier each night until they reach the target bedtime
Parents should be concerned about that because if that you want them to stick with during the school
children are sleep-deprived, “they’re not going to year.
give their best effort,” says Ron Kron, clinical man-
ager of the Sleep Disorders Center at Floyd Memorial Having a regular bedtime is important, even for teens,
Hospital in New Albany, Ind. who have unique challenges, she says.

Sleep “allows the body to restore and refresh itself,” Teenagers tend to “feel tired later and want to sleep
says Kron, a registered respiratory therapist. “If you later, and that’s a biological tendency.”
don’t get enough sleep ... you’re going to be tired and
drowsy through the day.” However, because of typical school times, “they have
to wake up early, they get sleep-deprived during the

Reprinted with permission. All rights reserved. Page 8


As seen in the Gannett News Service on Thursday, August 14, 2008

week and then they do sort-of catch-up sleep on the To help kids sleep, encourage them to relax before
weekends or (take) after-school naps,” she says. bed and to minimize light, even the glow from elec-
tronics. Such light “can be pretty powerful, and it
Honaker prefers that children not be allowed to sleep- sends a cue to the system that it’s time to be awake,”
in more than 30 to 60 minutes on weekends. Honaker says.

“Sleeping in longer than an hour can really cause In fact, the bedroom should be electronics-free, if
problems with their sleep schedule,” keeping them possible, she says. This will help remove the tempta-
from being sleepy at bedtime, Honaker says. tion to use them close to bedtime, allow parents to
monitor use more closely and create an association
The same goes for naps, which Honaker discourages between the bedroom and sleep.
except under special circumstances, such as sick-
ness. “The bedroom should be used basically to sleep,”
Kron agrees. “No television, no computers, no games.
Kron doesn’t oppose naps as long as they don’t keep When it’s time to go to bed, it’s time to go to bed.”
the child from sticking to his or her bedtime.

Reprinted with permission. All rights reserved. Page 9


Discussion Questions
uRefer back to the articles on lack of sleep, drowsy drivers and the possible boost to athletes from extra
sleep. Create a list of the mental, physical and emotional consequences of poor sleep. Add consequences
from your own personal experiences.

uShortened sleep time has been linked to health impairments as indicated in the articles on weight change
and Alzheimer’s links. In group or individual study, determine what you think are the top 5 causes of short-
ened/restricted sleep for you. What are the underlying reasons for each cause (e.g. culture, personal choice,
need-based)? How can one realistically prevent shortened sleep?

uSome research suggests that sleep-deprived drivers can be as dangerous as drunk drivers. Should there be
a law similar to a DUI for sleepy drivers? Create a mock debate for this ‘proposed’ law. Be sure to consider
how you will determine ‘sleepiness’, the guidelines for punishment (e.g. if adults need less sleep than teen-
agers are adults allowed to be sleepier than teenagers without fine?), and the implications for future laws.
Use other evidence to support or reject the ‘proposed law’.

uPeople with short sleep (6 hours or less) or too much sleep (9 or more hours) are more likely to be obese
than those sleeping about 8 hours a night. Given this evidence, a hypothetical ‘sleep diet’ appears which
claims that the average sleep deprived and overweight American can now “sleep themselves thin!” Write a
2-minute paper describing why you would or would not believe this ‘diet’ could work. (Hint: Which do you
believe happens first: Sleep changes or obesity?)

uGood sleep habits and hygiene may be just as important as diet and exercise for a healthy body and mind.
Individually or in groups, increase sleep hygiene awareness by creating a small skit, poster, brochure, or
commercial promoting healthy sleep habits.

Future Implications

uYour sleep/wake cycle is tightly linked to your body’s circadian rhythm. Your circadian rhythm includes
daily fluctuations in many things from gene expression to behavior (e.g. stress hormone levels, body tem-
perature). Often it is difficult for scientists to determine what is due to altering circadian rhythms and what
is due to altering sleep. How can we use our understanding of circadian rhythms to prevent sleep depriva-
tion?

uDr. Van Cauter found that healthy young adults undergoing sleep restriction for 1 week developed symp-
toms of metabolic syndrome. How is sleep linked to metabolism? How is sleep linked to other health prob-
lems (e.g. depression)?

uNew research suggests that people may not be able to “catch up” on lost sleep when chronically sleep re-
stricted. How do we determine an individual’s limit to sleep restriction and what are the consequences of
“permanently” losing sleep?

uHow can we maximize the quality and benefit of the sleep we are getting when we are able to get it?

uWhat other variables affect sleep? Do men and women respond differently to sleep challenges? How might
drugs (e.g. prescriptions, caffeine), light exposure, exercise, feeding patterns, and stress positively or nega-
tively affect sleep?

Reprinted with permission. All rights reserved. Page 10


Resources
uhttp://www.cdc.gov/sleep/hygiene.htm
udiabetes.org
uamericanheart.org
uarthritis.org
usleepfoundation.org
umentalhealth.org
uacg.gi.org
uheadaches.org

Expert bio: Deanna Arble

Deanna Arble is a graduate student in neuroscience at Northwestern University. Work-


ing with Professor Fred W. Turek, director of the Center for Sleep and Circadian Biology,
Deanna has co-authored various studies on sleep, circadian rhythms and metabolism.
She graduated from the University of Virginia in 2005 with a dual focus of neurosci-
ence and psychology.

Reprinted with permission. All rights reserved. Page 11

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