Reinstatement of neural activity is hypothesized to underlie our ability to mentally travel back in time to recover the context of a previous experience. We used intracranial recordings to directly examine the precise spatiotemporal extent of neural reinstatement as 32 participants with electrodes placed for seizure monitoring performed a paired-associates episodic verbal memory task. By cueing recall, we were able to compare reinstatement during correct and incorrect trials, and found that successful retrieval occurs with reinstatement of a gradually changing neural signal present during encoding. We examined reinstatement in individual frequency bands and individual electrodes and found that neural reinstatement was largely mediated by temporal lobe theta and high-gamma frequencies. Leveraging the high temporal precision afforded by intracranial recordings, our data demonstrate that high-gamma activity associated with reinstatement preceded theta activity during encoding, but during retrieval this difference in timing between frequency bands was absent. Our results build upon previous studies to provide direct evidence that successful retrieval involves the reinstatement of a temporal context, and that such reinstatement occurs with precise spatiotemporal dynamics.R einstatement of neural activity is hypothesized to underlie our ability to recover the internal representation of a previous experience, a process described as mental time travel (1-4). These internal representations, which may reflect the external environment or internal mental states, form the context in which an episodic memory is embedded. Central to the hypothesis of mental time travel is that context representations in the brain gradually change over time, and that successful retrieval of an episodic memory involves mentally jumping back in time to reexperience a particular context (5-8). Consistent with this paradigm, when an episode is successfully retrieved from memory, the memory for neighboring episodes that occurred close in time is enhanced, an effect known as contiguity (9). However, despite substantial behavioral data supporting this hypothesis, a number of important yet unanswered questions remain regarding its underlying neural mechanisms.Empiric support for neural reinstatement has largely emerged from functional MRI (fMRI) studies that have used multivoxel pattern analysis (MVPA) (10-12). MVPA relies on classifying neural activity during retrieval to dissociate broad manipulations such as category or task that are present during encoding (13-16). MVPA, however, is unable to directly examine whether successful retrieval reinstates the neural representations of individual items. Representational similarity analysis supports neural reinstatement of individual stimuli (17-19), but this alternative fMRI approach does not examine to what extent retrieval reinstates a changing neural representation of context. In addition, the limited temporal resolution of fMRI studies makes them unable to identify the precise spatiotemporal dynamics o...

BACKGROUND | Glycemic control is suboptimal in many individuals with type 2 diabetes. Although use of flash continuous glucose monitoring (CGM) has demonstrated A1C reductions in patients with type 2 diabetes treated with a multiple daily injection or insulin pump therapy regimen, the glycemic benefit of this technology in patients with type 2 diabetes using nonintensive treatment regimens has not been well studied.METHODS | This retrospective, observational study used the IBM Explorys database to assess changes in A1C after flash CGM prescription in a large population with suboptimally controlled type 2 diabetes treated with nonintensive therapy. Inclusion criteria were diagnosis of type 2 diabetes, age ,65 years, treatment with basal insulin or noninsulin therapy, naive to any CGM, baseline A1C $8%, and a prescription for the FreeStyle Libre flash CGM system during the period between October 2017 and February 2020. Patients served as their own control subject.RESULTS | A total of 1,034 adults with type 2 diabetes (mean age 51.6 6 9.2 years, 50.9% male, baseline A1C 10.1 6 1.7%) were assessed. More patients received noninsulin treatments (n 5 728) than basal insulin therapy (n 5 306). We observed a significant reduction in A1C within the full cohort: from 10.1 6 1.7 to 8.6 6 1.8%; D 21.5 6 2.2% (P ,0.001). The largest reductions were seen in patients with a baseline A1C $12.0% (n 5 181, A1C reduction 23.7%, P ,0.001). Significant reductions were seen in both treatment groups (basal insulin 21.1%, noninsulin 21.6%, both P ,0.001).CONCLUSION | Prescription of the flash CGM system was associated with significant reductions in A1C in patients with type 2 diabetes treated with basal insulin or noninsulin therapy. These findings provide evidence for expanding access to flash CGM within the broader population of people with type 2 diabetes.

SignificanceBiases and fallacies can nudge humans in one direction or another as they make decisions. During gambling, bias is often generated by internal factors, including individual preferences, past experience, or emotions, and can move a person toward or away from risky behavior. The neural mechanisms responsible for generating internal bias are largely unknown, limiting the treatment of patients with neurological diseases that impair decision-making. We applied mathematical modeling techniques and high-resolution intracerebral recordings to uncover how a hidden internal bias builds up from past experiences to influence decisions and where this internal bias is encoded in the brain. Our findings suggest that biology exploits a distributed lateralized push–pull neural system to govern counterintuitive and highly variable decision-making in humans.

Purpose Suboptimal glycemic control among individuals with diabetes is a leading cause of hospitalizations and emergency department utilization. Use of flash continuous glucose monitoring (flash CGM) improves glycemic control in type 1 and type 2 diabetes, which may result in lower risk for acute and chronic complications that require emergency services and/or hospitalizations. Methods In this retrospective, real-world study, we analyzed IBM MarketScan® Commercial Claims and Medicare Supplemental databases to assess the impact of flash CGM on diabetes-related events and hospitalizations in a cohort of 2,463 individuals with type 2 diabetes on short- or rapid-acting insulin therapy. Outcomes were changes in acute diabetes-related events (ADE) and all-cause inpatient hospitalizations (ACH), occurring during the first six months after acquiring the flash CGM system compared with event rates during the six months prior to system acquisition. ICD-10 codes were used to identify ADE for hypoglycemia, hypoglycemic coma, hyperglycemia, diabetic ketoacidosis and hyperosmolarity. Results ADE rates decreased from 0.180 to 0.072 events/patient-year (HR: 0.39 [0.30, 0.51]; p<0.001) and ACH rates decreased from 0.420 to 0.283 events/patient-year (HR: 0.68 [0.59 0.78]; p<0.001). ADE reduction occurred regardless of age or gender. Conclusions Acquisition of the flash CGM system was associated with reductions in ADE and ACH. These findings provide support for the use of flash CGM in type 2 diabetes patients treated with short- or rapid-acting insulin therapy to improve clinical outcomes and potentially reduce costs.