Brain Health in the Pervasive Neurotechnology Era

1. Brain Health in the Pervasive Neurotechnology Era

2. Welcome! #sharpbrains2015 Sponsors

3. Alvaro Fernandez, CEO of SharpBrains Welcome Remarks: Brain Health in the Pervasive Neurotechnology Era

4. 1) THE FACTS

5. 2) THE OPPORTUNITY

6. The Digital Revolution Meets The Human Brain = Pervasive Neurotechnology

7. How can consumers and professionals harness this opportunity to better monitor and enhance brain health, and to improve work and life? • Watercooler chats • LinkedIn • Session @ Expo Day • #sharpbrains2015 3) THE CHALLENGE

8. How to harness neuroplasticity and digital tools to enhance work and life Chaired by: J. Peter Kissinger, President and CEO of the AAA Foundation for Traffic Safety Dr. Peter Delahunt, Research Scientist at Posit Science Dr. Ruth Wolever, Chief Science Officer at eMindful Danny Dankner, CEO of Applied Cognitive Engineering (ACE) Brig. General Pete Palmer, Director of the EDGE Innovation Network

9. J. Peter Kissinger President and CEO

10. AAA Foundation • Established in 1947 • 501(c)(3) Not-For-Profit • Research affiliate of AAA/CAA • North American Focus • Funded Through Generosity of: Mission: • Identify traffic safety problems • Foster research that seeks solutions • Disseminate information & educational resources “Saving lives through research and education”

11. 2015 Major Research • Over 20 active projects including:  Safety Culture  Teen Driver Safety  Distracted Driving  Cognitive Distraction  American Driving Survey  Senior Safety & Mobility – the LongROAD Study  Cannabis studies

12. Drive Sharp – Brain Retraining for Seniors • Launched in 2009 in collaboration with Posit Science • Computer based training • Done at home • Ten hours to complete www.drivesharpnow.com

13. November 2015 Peter B. Delahunt, Ph.D. Posit Science Corporation, San Francisco, CA. Reducing auto crashes in real-world populations: A direct demonstration of generalization of cognitive training to functional abilities

14. A Brief Introduction to Posit Science • Founded in 2003 to bring brain plasticity out of the lab and into the world • Spun out of UCSF • Funded by leading venture capital groups, NIH grants, and sales income 16 Where We Came From What We Do Where We’re Going • Invent New Science: Apply brain plasticity to build software-based cognitive training programs that work • Get Science to People: Build programs that people love, and work with great partners to reach millions of people • Science to the people! • Brain fitness as a core part of everyone’s life

15. 17 0 500 1000 1500 2000 2500 Crashes/100millionmilesdriven AGE AAAFTS report (2013) -- data from 2008-09 Younger and older drivers have elevated crash risk. Evidence that cognitive training reduces crash risk in older population. Potential for teens. AAA Foundation for Traffic Safety (AAAFTS) were interested in getting this research into a real world setting Will discuss two current projects with AAAFTS and AAA clubs: • Older drivers • Teen drivers Crash rates across lifespan show u-shaped function – youngest and oldest are riskiest

16. 18 Cognitive decline begins in our 30’s and continues throughout life. Slower visual processing and reduced attentional capacity lead to reductions in Useful Field of View (UFOV). Developed by Drs. Karlene Ball and Dan Roenker. UFOV: The area over which you can extract visual information at a brief glance without head or eye movement. Drivers with poor UFOV twice as likely to crash. Older drivers with poor cognition are twice as likely to crash 2.2 1.9 2.0 2.2 0.0 1.0 2.0 3.0 Owsley 1998 Sims 2000 Ball 2006 Rubin 2007 Relativecrashrisk

17. 19 •Quicker reaction time - stop 22 feet sooner 55 mph (Roenker et al., 2003). •Reduced dangerous driving maneuvers by 36% (Roenker et al., 2003). •Maintained driving space and driving in difficult situations (Edwards et al., 2009). •Reduced risk of driver cessation by 40% in drivers with poor UFOV (Edwards et al, 2009). •Reduced at-fault crash incidences by ~50% in 5 years following training (Ball et al, 2009). UFOV training reduces crash risk in older drivers

18. 20 Exercise 1 (UFOV) Exercise 2 (MOT) • Developed with Karlene Ball and Dan Roenker • Online computer-based training • 8 to 10 hours to complete • Two exercises • Engaging Drivesharp development goal -- make UFOV widely available and engaging

19. From Clinical Trials To Field Trials Clinical trials are required for establishing efficacy • Carefully selected study populations • Tight control of program use • Random group assignment • Placebo controls • Complex cognitive function measures • Blinded raters 21 Field studies are required for establishing effectiveness • Very broad study populations • Very limited control of program use • Randomization typically difficult or inappropriate • Non-participant control groups • Database derived outcome measures from naturally accruing data

20. 22 Drivesharp project with AAAFTS / AAA Offered by a number of AAA Clubs including Auto Club of Southern California Offered to auto policyholders age 55 plus Incentive: 4.7% insurance discount for 3 years Launched: March 2012 Registered: 20,736 Completers: 4,737 (23%) Analysis plan

21. 23 Red: pre-training Blue: post-training Completers only ~30% drop in claims rate in first year Booster training Drivesharp analysis first look -- 30% drop in crash rates

22. 24 Search Failures Attention Issues Inappropriate Speed • Inadequate search at junctions and before lane changes • Look away from road too long • Maintaining focused attention on road • Prone to distraction • Too fast in low visibility conditions 40% 25% 25% Teen drivers – main causes of crashes 0 500 1000 1500 2000 2500 Crashes/100millionmiles driven AGE

23. Attention and search under a range of driving conditions Eye movements under cognitive load Focused central attention while monitoring periphery • Online training • 8-10 hours • 3 exercises • Embedded in metagame InGear training software to reduce teen crash risk

24. • Offered to teens of existing policyholders (ages 15-19) • Incentive: $100 on completion • Parents can monitor progress • Registrants 20,910 • Completers 3,348 (16%) • Enough data to start analysis • Analysis plan 26 InGear project with AAAFTS / AAA

25. Thank you 27

26. Building neuroplasticity through live, online mindfulness programs Ruth Wolever, PhD Chief Scientific Officer ruth@emindful.com (772) 569-4540 Some of our clients: Aetna Humana NextEra Energy State of Arizona

27. eMindful at a Glance Only providerof live, online wellness programs that are: • Built upon applied mindfulness, evidence-based & scalable Over 6 years working with major national health plans & their clients

28. Overview • Mindfulness and Applied Mindfulness Defined • Background: Mindfulness in the Workplace • What the Data Shows • Implications for Neuroplasticity Today’s presentation is 15 minutes.

29. Mindfulness is Now Mainstream

30. Mindful Awareness Attitude Key Elements of Mindfulness “Paying attention.” “On purpose.” “In the present moment, non- judgmentally.” Adapted from Shapiro et al. (2006). J Clin Psychol.

31. • Unhealthy lifestyle is driven by numerous unhealthy habits that have become default behaviors in our environments • Automatic pilot behaviors are mostly outside of our awareness (cue followed by series of behaviors, followed by reward - linked in a neurological pathway) • Choice arises as participants notice and understand how thoughts, emotions, sensations and urges to act influence behaviors • By working with components separately, strengthen ability to change perception, emotional states, physiology and behavior. Applied Mindfulness

32. Decreased Pain Decreased Anxiety & Depression Decreased Stress- Related Medical Symptoms Improved Attention Improved Brain Function & Structure Improved Behaviors Benefits of Mindfulness

33. At the time of the study, no published dissemination studies on mindfulness- based workplace stress reduction programs To be feasible for employees, must be easily accessible Research: Mindfulness at Work Background Burgeoning literature evaluating mind-body programs in clinical settings Minimal literature evaluating mind-body programs in the work place At the time of the study, only 4 RCTs (3 of them small) No studies on use of virtual classroom for health and wellness experiential programs Need to disseminate from the “Ivory Towers” and Clinical Arenas

34. Used ITT principles and 2 (pre – post) X 2 (group) repeated measures ANCOVA procedures Baseline site differences within control group in race, ethnicity and income so retained these as covariates in RM ANCOVAs No baseline differences between Mindfulness at Work™ and control groups in sociodemographics or key study variables Research: Mindfulness at Work Analysis: MAW versus Controls

35. Group X time interactions significant for: PSS [F(1,144) = 21.31, P < .001] Sleep quality [F(1,144) = 5.17, P < .05] Mindfulness [F(1,144) = 5.75, P < .05] Heart Rhythm Coherence [F(1,144) = 4.25, P < .05] Randomized Controlled Research: Mindfulness at Work Results: MAW versus Controls

36. 10 min resting baseline pre- intervention 4 min “stress preparation” period post- intervention wherein participants were instructed to prepare themselves mentally and emotionally for an upcoming important challenge Calculated using interbeat intervals continuously sampled at 250 Hz during: Difference between baseline and stress preparation Randomized Controlled Research: Mindfulness at Work Improvements in Heart Rhythm Coherence

37. Randomized Controlled Research: Would the program be as effective online in a virtual classroom? Used ITT principles and 2 (time) X 2 (group) repeated measures ANCOVA procedures Race, ethnicity and income again retained as covariates since baseline differences across venues (online vs in- person) in income, and in all 3 sociodemographic variables across sites

38. No group X time interactions for PSS, sleep quality, mindfulness, depressive symptoms or work productivity Significant group X time interaction for Heart Rhythm Coherence [F(1,91) = 3.91, p < .05]; online group showed greater improvement Likely due to attrition differences Randomized Controlled Research: Results: MAW Online versus In-Person

39. Randomized Controlled Research: Mindfulness at Work Attrition  The online mindfulness group had an extremely low attrition rate (4%)  Significantly lower than the attrition for the in-person group (27%), which was more typical for behavioral trials  No differences in attrition between MAW and controls  No baseline differences between attriters and completers

40. In terms of outcomes, delivery through a virtual classroom was as effective as in-person delivery. Online classes had significantly higher completion rate. Perhaps the better retention rate in the online group related to digital opportunities to view the class at later, more convenient times. This needs further study.

41. Financially Positive "...we saw dramatic drops … we saw a $3,000 reduction in their healthcare costs for the next year." - Mark Bertolini, CEO Aetna

42. Decreased amygdala density after Mindfulness-Based Stress Reduction (MBSR) From Hölzel et al. (2010). SCAN Reductions in right amygdala gray matter density correlate with changes in perceived stress; the more someone lowered their stress, the more neuroplastic change observed after a course of mindfulness training.

43. MBSR alters functional connectivity From Kilpatrick et al. (2011) NeuroImage

44.  For individuals, training in mindfulness through a virtual classroom lowers stress (perceptually & biologically), enhances sleep, and improves neuroplasticity. Smart phones now allow increased access and convenience to eMindful programs.  For employers, results are seen in the bottom line – greater productivity, lower heatlhcare costs, employees that can focus and learn more effectively Bottom Line

45. To “Enhance Work and Life,” Listen to the Life Stories Outside the Data “This class...has been life-changing for me. I know I am a better mother. I know I’m a better wife. I know that I’m a better daughter because of this class. And my goals are to continue using the teachings that I have learned, even without the continued support of everyone else in the class…”

46. Mindful Awareness Course participants see powerful results Reduced stress Stopped smoking 29 Reversed metabolic syndrome 5540 Gain in productivity per week 47% %%mins

47. Since 2007 We have helped thousands of people, in more than 135 countries, with important issues such as stress, smoking, diabetes, cancer, chronic pain and metabolic health.

48. 50/42Click to edit Master title style Cognitive Simulation in the service of Competitive Sports Danny Dankner, CEO ACE Applied Cognitive Engineering, Inc.

49. 51/42Click to edit Master title styleFocus: Targeted Training (Profession / Task)

50. 52/42Click to edit Master title styleComplex Cognitive System

51. 53/42Click to edit Master title styleCompetitive Sports Arena Extreme value to performance enhancement Rich in statistics, efficacy highly visible Clear need; missing training protocol

52. 54/42Click to edit Master title style Mapping the cognitive skill-set of the specific domain (e.g.: Hand eye coordination, Attention, Decision making, Perception, Spatial orientation) Training the cognitive skill-set via Cognitive Simulation US Patent Number 7887239 ACE’s Patented Technology: Cognitive Simulation 5 Habanai St., Hod Hasharon,  

53. 55/42Click to edit Master title styleReading the Game

59. 61/42Click to edit Master title style 5 Habanai St., Hod Hasharon, Actual Training Environment

60. 62/42Click to edit Master title style 5 Habanai St., Hod Hasharon, Demonstrating Various Training Scenarios Clouds – partial hiding Long threat Moving goals Spotlight

61. 63/42Click to edit Master title styleMembers Area – Reports Module

62. 64/42Click to edit Master title styleThe Hockey IntelliGym – Case Study

63. 65/42Click to edit Master title styleResults in Ice-Hockey: International Titles! Year Gold Silver Bronze 1999 Finland Sweden Slovakia 2000 Finland Russia Sweden 2001 Russia Switzerland Finland 2002 USA Russia Czech Rep. 2003 Canada Slovakia Russia 2004 Russia USA Czech Rep. 2005 USA Canada Sweden 2006 USA Finland Czech Rep. 2007 Russia USA Sweden 2008 Canada Russia USA 2009 USA Russia Finland 2010 USA Sweden Finland 2011 USA Sweden Russia 2012 USA Sweden Canada 2013 Canada USA Finland 2014 USA Czech Rep. Canada 2015 USA Finland Canada ICE HOCKEY U18 WORLD CHAMPIONSHIP

64. 66/42Click to edit Master title styleResults in Ice-Hockey: International Titles! USA U18 National Team adopts the IntelliGym. Goals per Player increased by 42% Year Gold Silver Bronze 1999 Finland Sweden Slovakia 2000 Finland Russia Sweden 2001 Russia Switzerland Finland 2002 USA Russia Czech Rep. 2003 Canada Slovakia Russia 2004 Russia USA Czech Rep. 2005 USA Canada Sweden 2006 USA Finland Czech Rep. 2007 Russia USA Sweden 2008 Canada Russia USA 2009 USA Russia Finland 2010 USA Sweden Finland 2011 USA Sweden Russia 2012 USA Sweden Canada 2013 Canada USA Finland 2014 USA Czech Rep. Canada 2015 USA Finland Canada ICE HOCKEY U18 WORLD CHAMPIONSHIP

65. 67/42Click to edit Master title styleOur Vision: IntelliGymTM brain workout is a part of the training routine of every competitive athlete.

67. © 2015 EDGE Innovation Network. All rights reserved.© 2015 EDGE Innovation Network. All rights reserved. Challenges with Current Measurement Tools 1. A majority of the cognitive measurement systems were designed to identify differences as they relate to injury, disease and mental disorders. They weren’t used to identify the different types of ‘normal’. 2. These tools were developed largely from assessment of men not women. 3. A majority of the military cognitive tools that are used/accepted are based on1980s technology or earlier. 4. Since most of the tools have dealt with abnormal behavior conditions, and primarily for medical purposes, regulations like HIPAA regulations creates a significant burden on information sharing. 12/3/2015Introduction to the EDGE® | What is the EDGE® and How Does it Work? 69

68. © 2015 EDGE Innovation Network. All rights reserved.© 2015 EDGE Innovation Network. All rights reserved. TFA Rating 12/3/2015Introduction to the EDGE® | What is the EDGE® and How Does it Work? 70 Think Executive Function Fluid Intelligence Circadian Rhythm Grit/Drive Experience/Crystalline Intelligence Moral/Ethics Feels Resilience Outlook Social Intuition Self-Awareness Sensitivity to Context Attention Acts Fact Finder Follow Thru Quick Start Implementer

69. © 2015 EDGE Innovation Network. All rights reserved.© 2015 EDGE Innovation Network. All rights reserved. Using the TFA Rating 1. Self Assessment or Baselining 2. Training and Education 3. Capabilities Development of KSA/KPP 4. Industry Production Range 5. Development of Cognitive Aide and Augmentation Tools 6. Leader Tools and Processes for Cognitive Operational Readiness 12/3/2015Introduction to the EDGE® | What is the EDGE® and How Does it Work? 71

70. Summit is on a short “Bio” Break. (we will resume at 10:00am Pacific Time) Chat forums will be available during the Watercooler session

71. To learn more, visit sharpbrains.com

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