How Tetris can soothe after trauma

But a new study has shown that playing the computer game Tetris within hours of experiencing trauma can prevent those feelings from taking over your mind.

PTSD occurs when intrusive memories linked to fear from a traumatic event become consolidated in a person’s mind by them visualizing the event in a loop until it becomes locked in their brain.

Competing with the visualization, such as with a game like Tetris, can block that consolidation form happening.

“An intrusive memory is a visual memory of a traumatic event,” said Emily Holmes, Professor of Psychology at the Karolinska Institute in Sweden, whose team led the study. “Tetris also requires imagination and vision. Your brain can’t do two things at once, so this interrupts.”

Tetris is a simple, visual and addictive computer game in which the goal is to line up falling shapes to form rows that then disappear when aligned. As rows disappear, more shapes fall and the longer the game lasts, the higher the score.

The goal in Tetris is to line up falling shapes to form rows that disappear when aligned.

The goal in Tetris is to line up falling shapes to form rows that disappear when aligned.

The goal in Tetris is to line up falling shapes to form rows that disappear when aligned.

Holmes hopes that use of these simple and early strategies with patients could help prevent the onset of PTSD. The current standard treatment doesn’t begin until after people develop the condition.

PTSD is estimated to effect 3.5% of adults in the US, according to the National Institute of Mental Health. The percentage is similar globally, at 4.6%, according to the World Health Organization.

Effective soon after an accident

Researchers tested the game on 71 patients in a UK emergency room who were seeking care after a motor accident. Half of them received standard care for their injuries, while the other half received a psychological intervention within six hours of their accident in which they were asked to recall their trauma, practice playing Tetris and then given the game to play on their own.

The patients were then monitored for one week, during which time they tracked how often they had memories, or flashbacks, relating to their accident. The people who has played Tetris reported 62% less memories on average over the week.

“After two days they had gone down to pretty much zero,” Holmes told CNN.

Researchers have long believed that intervening early — within hours or days of the event — could stop the fearful memories from developing in the brain. This is the first study using something as simple as a computer game.

Holmes has been researching the use of Tetris in this way for more than a decade in the lab and this proof-of-concept study is the first time she has experimented with patients.

The research remains in it’s early stages, she stresses. What we need to do is a larger study,” said Holmes who also hopes to monitor the effectiveness of her approach over a longer period of time, up to six months.

The need for more insight using a larger cohort of people was raised by consultant Mark Salter from the Royal College of Psychiatrists, as well as the need to test options other than Tetris. “The study is small … and not everyone plays Tetris or is computer literate,” he told CNN. He added that there is also the challenge of “getting someone to participate when they’ve just seen something terrifying.”

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But he was intrigued by the findings and the ability of this prevention measure to be given soon after someone experiences a trauma. “What’s exciting about this is that it happens quickly,” he said. “It allows an immediacy to the intervention.”

Salter said the approach needs to include other options that are more universally acceptable since “it’s not just Tetris that does this.”

Holmes said that anything visual and engaging could have a similar effect. But, he added, other engrossing activities using other parts of the brain, such as number or word activities, may not work, or make things worse.

Meditating can help you live to 100

In the past, my family and friends would’ve typically described me as pleasant but hurried. My baseline restlessness and edginess, however, have now nearly vanished.

Without difficulty, I have sustained attention when my young children spend time with me. Instead of constant surveillance of my phone, there is an ability to quickly hyper-focus on the task is at hand and a corresponding joy of living in a distraction-less world.

This change seems to have started the end of last year, after I spent a morning meditating with the Dalai Lama.

First off: Yes, I do feel a little ridiculous writing a line like that, and I didn’t feel worthy of his invitation at the time. Even though I meditate, I’ve never been sure whether I was using proper technique or whether there was an acceptable way to meditate in the presence of His Holiness.

If he was looking forward to a good meditation partner, I worried he was unlikely to find it in me. Even my posture is terrible when sitting cross-legged on the floor. My back starts to hurt, followed by my knees. Thus, my breathing, which is supposed to drive my focus, sounds raspy and uneven. All this makes my mind race instead of slowing down and calming.

Just thinking about meditating with His Holiness was making me anxious.

Nevertheless, who says “no” to a chance to meditate with the Dalai Lama? I agreed to join him early the next morning at his private residence.

A practice that begins at 3 a.m.

At 81 years, old, the Dalai Lama keeps a very active schedule. I met him in Mundgod, India, at the Drepung Monastery, where he was overseeing a symposium bridging Buddhism and science.

The monastery itself is a dazzling bejeweled structure built 600 years ago. Inside, there are enormous golden Buddhas standing next to ornate walls. The discussion hall itself is grand but warm, with doors and windows open to the hot South Indian sun.

For three days, his Holiness moderated sessions on weighty metaphysical topics such as the criteria for valid reasoning, the fundamental constituents of the universe, origins of life and the subjective experience of the mind.

It was fascinating and mind-bending — but also mentally exhausting. It was difficult to stay awake, let alone keep up with the rapid-fire debate between the Buddhists and the scientists. Yet his Holiness was mentally engaged and inquisitive throughout, even more remarkable given more than half the comments were being translated for him.

The Dalai Lama typically wakes about 2:40 a.m. and starts his daily meditation routine at 3 a.m., even as most of his staff is still snoozing.

This was the backdrop when one of his senior staff members picked me up outside the monastery early one morning. We drove in a three-car convoy to the gates outside his private residence.

From there, several more staff members escorted us to a small conference room where his security detail was slowly waking and drinking their morning tea. Finally, his chief of staff walked me just outside the personal quarters of the Dalai Lama.

Meditating is hard for him, too

There were a few minor instructions before we entered. Eye contact is not a problem, and shaking hands is acceptable if you use two hands, not just one. Try not to turn your back to him when leaving the room, and instead walk backward, as much as possible facing him. When sitting cross-legged on the floor, don’t point your feet at the Dalai Lama. And the correct address is “your holiness.”

Shortly after, the doors opened, and I nervously walked into a very modest room where the Dalai Lama was sitting on a raised platform, already deep in meditation. I slipped off my shoes, sat cross-legged at a slight angle on the floor to avoid my toes being pointed in his direction, closed my eyes and started to focus on my breathing.

All my meditation insecurities immediately started to kick in. After a few minutes, I heard his deep, distinctive baritone voice: “Any questions?”

I looked up and saw his smiling face, starting to break into his characteristic head-bobbing laugh.

“This is hard for me,” I said.

“Me, too!” he exclaimed. “After doing daily for 60 years, it is still hard.”

It was at once surprising and reassuring to hear him say this. The Dalai Lama, Buddhist monk and spiritual leader of Tibet, also has trouble meditating.

“I think you will like analytical meditation,” he told me. Instead of focusing on a chosen object, as in single-point meditation, he suggested I think about a problem I was trying to solve, a topic I may have read about recently or one of the philosophical areas from the earlier sessions.

He wanted me to separate the problem or issue from everything else by placing it in a large, clear bubble. With my eyes closed, I thought of something nagging at me — something I couldn’t quite solve. As I placed the physical embodiment of this problem into the bubble, several things started to happen very naturally.

The problem was now directly in front of me, floating weightlessly. In my mind, I could rotate it, spin it or flip it upside-down. It was an exercise to develop hyper-focus.

Less intuitively, as the bubble was rising, it was also disentangling itself from any other attachments, such as subjective emotional considerations. I could visualize it, as the problem isolated itself, and came into a clear-eyed view.

Too often, we allow unrelated emotional factors to blur the elegant and practical solutions right in front of us. It can be dispiriting and frustrating. Through analytical meditation, His Holiness told me, we can use logic and reason to more clearly identify the question at hand, separate it from irrelevant considerations, erase doubt and brightly illuminate the answers. It was simple and sensible. Most important, for me — it worked.

Meditation for skeptics

As a neuroscientist, I never expected that a Buddhist monk, even the Dalai Lama, would teach me how to better incorporate deduction and critical thinking to my life — but that is what happened.

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It changed me. And I am better for it. I practice analytical meditation every day, usually early in the morning. The first two minutes are still the hardest, as I create my thought bubble and let it float above me. After that, I reach what can best be described as a “flow” state, in which 20 to 30 minutes pass easily.

I am more convinced than ever that even the most ardent skeptics could find success with analytical meditation.

Over the holidays, I spent as much time as possible relaying the Dalai Lama’s teachings to my family and friends and teaching them basic principles of analytical meditation. This was the gift I most wanted to share with them. And now with you.

A religion for society’s unwanted

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Study: Greatest rise in heroin use was among whites

More people die from drug overdoses than from guns or car accidents. At the peak of the AIDS epidemic in 1995, 43,115 people in the United States died from the disease.

Furthermore, since 1999, the number of overdoses from prescription opioids like oxycodone and hydrocodone, as well as illicit drugs like heroin, have quadrupled. In fact, heroin now accounts for one in four overdose deaths in the United States.

Now, a new study in the journal JAMA Psychiatry looks beyond the total number of overdose deaths to get a better picture of how heroin use patterns have changed since 2001. Since then, the number of people who have used heroin has increased almost five-fold, and the number of people who abuse heroin has approximately tripled.

The greatest increases in use occurred among white males.

Heroin use on the rise

The authors evaluated the responses of 79,402 individuals, as collected from the 2001-2002 and the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions, a longitudinal study conducted by the National Institutes of Health to evaluate alcohol and drug use and abuse. While heroin use between whites and non-whites was fairly similar in the 2001-2002 results, at 0.34% and 0.32% respectively, by 2012-2013 the percentage of whites who had used heroin jumped to 1.90%. Just 1.05% of non-whites in 2012-2013 used heroin. Heroin use also increased significantly among those with a high school education or less, as well as those who lived at less than 100% of the federal poverty line.

The authors of the new report write “these trends are concerning because increases in the prevalence of heroin use and use disorder have been occurring among vulnerable individuals who have few resources to overcome problems associated with use.”

According to a 2016 Surgeon General’s report on alcohol, drugs and health, only one in 10 of those with a substance use disorder receive any treatment.
“The good news is that among all drugs of abuse, heroin and opioids have by far the best treatment medications available. Methadone and buprenorphine have proven effectiveness data, they not only reduce the chances of dying from an opioid overdose by 50%, they support people being in recovery from their addiction and reduce health care costs and improve a wide array of other outcomes,” said Caleb Banta-Green, an associate professor of health services at the University of Washington. Banta-Green was not involved in the study.

Starting with prescription drugs

The study also confirmed the idea that many heroin users start by using prescription opioids like oxycodone and hydrocodone. Approximately one-third of all white heroin users reported using prescription drugs for non-medical purposes in 2001-2002. By 2013 more than half of all white heroin users started by initially using prescription drugs. For non-whites, the number of people who started by using prescription drugs before heroin actually dropped in the same time frame.

An accompanying editorial by Bertha Madras, a psychologist at McLean Hospital in Massachusetts and former deputy director in the White House’s Office of National Drug Control and Policy pointed to the shift in treating pain as a major factor in understanding the current crisis. She noted that in the past two decades, the number of opioid prescriptions has risen three-fold.

“This shift in practice norms was fueled by acceptance of low quality evidence that opioids are a relatively benign remedy for managing chronic pain,” she wrote. “These vast opioid supplies created a risk for diversion, opioid misuse and disorder, and overdose death.”

The study did not find any significant difference when looking at what age groups were using heroin, but heroin dependency and addiction was significantly higher for those below the age of 45 than those above. That should be a cause of concern, said Banta-Green, who noted that one of the costs of overdoses and abuse to society is lost productivity.

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A county-by-county study released Wednesday by the Robert Wood Johnson Foundation, calculated that drug overdose deaths resulted in a 778 years of potential life lost for every hundred thousand people. This report also found that most of the increase in premature deaths in 15- to 44-year-olds is due to drug overdoses. And while no community is immune to this crisis, suburbs, which used to have the lowest rates of premature deaths from drug overdoses now have the highest rates.

The authors of the longitudinal study note that “heroin use appears to have become more socially acceptable among suburban and rural white individuals, perhaps because its effects seem so similar to those of widely available [prescription opioids].”

The findings of these new reports are in line with earlier research over the past two decades about increasing heroin and opioid overdoses. “The trend isn’t a surprise — the takeaway is what matters. Heroin use disorder is a serious medical condition with which individuals are likely to struggle for the rest of their life. We need to give them the tools they need to survive and thrive,” said Banta-Green.

Will Trump switch to iPhone from Android?

Trump’s social media director, Dan Scavino, said late Tuesday on Twitter that the president has been tweeting from “his new iPhone” for the past couple of weeks. But a tweet bearing the hallmarks of Trump’s combative style came from an Android device as recently as Saturday.

The matter has potential national security implications.

During the early weeks of his presidency, Trump came under scrutiny over reports he was continuing to use his old, unsecured Android phone to send tweets to the 27 million followers of his @realDonaldTrump account.

“The national security risks of compromising a smartphone used by a senior government official, such as the President of the United States, are considerable,” two Democratic senators wrote in a letter to Defense Secretary James Mattis last month asking for more information about the president’s mobile devices.

At the time of his inauguration, Trump was reported to have traded in his Android phone, believed to be a Samsung, for a secure device. But @realDonaldTrump tweets marked as coming from “Twitter for Android” kept appearing.

The concern, according to the senators, is that hackers may be able to break into an unsecured device and “turn on audio recording and camera features, as well as engaging surveillance tools that allow location and other information tracking features.”

Related: Senate Democrats want answers about Trump’s phone

Earlier this month, the Android-marked tweets dried up for a while and more iPhone tweets appeared. Some news organizations suggested the president might have switched phones.

But on Saturday, a typical Trump tweet with the Android tag popped up, declaring that “ObamaCare will explode.”

The White House declined to say whether any of the devices being used by Trump were secure.

“We don’t discuss the security measures that are or have taken place,” press secretary Sean Spicer told CNNMoney by email Wednesday.

Related: The Presidential Records Act and @realdonaldtrump

Intelligence officials went to great lengths to provide former President Barack Obama with a secure BlackBerry that he could use to communicate with his advisers.

Security researchers say it’s tougher to compromise iPhones than Android devices, but not impossible.

Trump used an iPhone early in his campaign, a time when he also criticized Apple (AAPL, Tech30) for making products overseas. In February 2016, he called for a boycott of Apple products over the tech giant’s refusal to help the FBI break into an iPhone used by one of the San Bernardino attackers.

“I use both iPhone & Samsung. If Apple doesn’t give info to authorities on the terrorists I’ll only be using Samsung until they give info,” he tweeted. Apple didn’t back down, and Trump eventually appeared to stop tweeting from an iPhone.

Related: Trump voters to president: Stop Twitter rants

Some observers had used Trump’s iPhone abstinence as a way of guessing which tweets from the @realdonaldtrump account he’d actually written himself.

Android-marked tweets, believed to be direct from Trump, tended to be angrier and use all caps liberally. More restrained tweets, often promoting Trump events, would be posted from an iPhone, presumably by aides.

Now, both styles of tweet are coming from iPhones, with a little Android still mixed in.

CNNMoney (Hong Kong) First published March 29, 2017: 11:08 AM ET

This skyscraper is out of this world

Clouds Architecture Office has unveiled plans for a futuristic skyscraper dubbed the “Analemma Tower.” The building would hover majestically above the ground because it would be attached — wait for it — to an actual asteroid, in space, that is forcibly put into orbit around the earth.

If that’s not enough to digest, consider that your exact address in this pendulous pad could be anywhere on Earth. The tower will be suspended via high-strength cabling from an asteroid and placed in “eccentric geosynchronous orbit”. In other words, it would be always moving — residents and visitors would take a daily journey between the northern and southern hemispheres with a prolonged visit over a main “home” point like New York City or Dubai (it’s always New York City or Dubai, isn’t it?)

In 2015 the European Space Agency’s Rosetta Mission successfully landed on the surface of the comet Churyumov-Geraismenko showing that it is possible to interact with such smaller bodies in space. NASA’s “Asteroid Redirect Mission” is scheduled to send a robot to collect a boulder off an asteroid and then place that boulder into a stable orbit around the moon.

In like fashion, CAO plans to use an asteroid harnessed with high strength cabling reaching towards earth to hold the skyscraper along its journey.

Analemma Tower’s designer Ostap Rudakevych told CNN that the tower could be made of durable and lightweight materials such as carbon fiber and aluminum. Advances in cable engineering would be needed to achieve the cable strength required to support the structure. Power would come from space based solar panels that have a constant exposure to sunlight. Water for the tower will be captured from clouds and rainwater and maintained in a semi-closed loop system.

As proposed the top of the tower sits at 32,000m and would be expected to reach speeds of 300mph as it travels through the sky.

How you would hang out

The design leaves some pretty important questions to be answered, like, “What do I do if I want to also have a life on the ground?” “Won’t my family and friends miss me because they will only have a finite window each day in which to see me, and even then, I will be floating above the earth, unable to make contact?”

The upper reaches of Analemma would extend beyond the troposphere

The upper reaches of Analemma would extend beyond the troposphere

The upper reaches of Analemma would extend beyond the troposphere

If you have to ask these questions then, we hate to say it, you are probably not ready to live in a huge mobile asteroid tower, but the designers have your back nonetheless.

Rudakevych said he envisions large passenger drones allowing people to move back and forth between the tower and earth’s surface along with cutting edge electro-magnetic elevators moving people throughout the this fantastic vision.

Currently the proposal calls for the tower to be mid-air over Dubai which has a long history of building tall and stylish skyscrapers at a fraction of the cost of U.S. based construction.

When asked what inspired such a project, Rudakevych said, “Since humans have emerged from caves our buildings have been growing ever taller and lighter. We believe that some day buildings will break free from earths surface, releasing us from harmful floods, earthquakes and tsunamis. Analemma Tower is a speculative idea for how this might be achieved some time in the future.”

What caused deadly outbreak at these hospitals

UPMC informed the Allegheny County Health Department, Pennsylvania Department of Health, and U.S. Centers for Disease Control and Prevention that its independent testing led UPMC officials to believe the linens were the likely source of the outbreak, according to the emails.

The new emails reveal additional testing seeking to pinpoint the source of the outbreak.

An email sent May 5, 2016, by Jeff Miller, a field epidemiologist for the CDC, said that environmental samples were taken on February 21, 22 and April 21, 2016, at UPMC Presbyterian and Montefiore hospitals and Paris Co. laundry facilities. The testing was requested by UPMC and conducted by an independent contractor.

A whole genome sequencing report by an independent laboratory based on these specimens “[suggests] that fungi from Paris have been brought into the [Presbyterian University Hospital] laundry,” according to the report provided in the email.

“It is looking more likely than ever, that the linen vendor is the more likely potential source of mucor as you can see by the reports,” said an email sent by Allegheny County Health Department Chief Epidemiologist LuAnn Brink on June 21, 2016, in which she shared “notes from UPMC.” It is unknown who from UPMC sent Brink the notes. Mucor is a species of mucormycosis, which are fungal spores commonly found outdoors. However, they can cause a rare and sometimes fatal fungal infection in patients who are immunocompromised, according to the CDC.

A whole genome sequencing report compares environmental samples from which the DNA has been extracted and sequenced to show the fingerprint of the sample at a high resolution, according to Dr. Barun Mathema, an assistant professor of epidemiology at Columbia’s Mailman School of Public Health who CNN contacted independently on Monday.

“Nobody is a 100% sure, if you read carefully, there will always be a bit of a wiggle room caveat,” said Mathema, who was not involved in testing the samples from Pittsburgh. In general, it is rare that epidemiological testing comes to an absolutely conclusive result because of variables that come into play when epidemiologists attempt to replicate the exact environment in which the case occurred.

Additional testing

This isn’t the first report to link the mold outbreak to hospital linens. In a separate, UPMC-contracted internal report, testing conducted on February 1, 2016 by hospital environmental specialists Andrew Streifel and Michael Buck found a heavy buildup of lint and mold near the Paris Co. linen facility vent through which unfiltered air dried the linens.

When Streifel and Buck went to the hospitals and tested linen from Paris Co., a cart of wet sheets delivered to the Montefiore laundry storage area bore “heavy fungal growth of Mucor and rhizopus,” according to their report, which was not made public until early 2017.

“Our hospitals are safe, and our ongoing monitoring and testing show no evidence of a mold outbreak. We and the nation’s top health regulators have found no definitive or unifying cause of the previous infections, which are known to occur on occasion at most major medical centers,” UPMC spokeswoman Allison Hydzik said in a statement to CNN when asked to respond to the contents of these emails.

UPMC “will address specific allegations in court and not in the media,” Hydzik said.

The Allegheny County Health Department provided CNN with the emails, which were incorrectly redacted to reveal more information than intended. The emails were provided in response to an open records request under the state’s Right to Know Law. The county records department withheld several other emails on the grounds of privacy for patients’ information.

“While we were made aware of all steps that UPMC was taking to identify potential sources, including looking at linens, there was no identification of the linens as the source of the outbreak. Similarly, as has already been stated by the department, ACHD was an observer in this process, not the regulatory agency looking into this,” Allegheny County Health Department spokeswoman Melissa Wade said in a statement to CNN when asked about the emails.

“Our products are safe. We have nothing to hide. We have followed and continue to follow protocols of the Healthcare Laundry Accreditation Council by providing hygienically clean linens to our customers,” Paris Co. CEO Dave Stern said in a statement to CNN when asked about the content of the emails.

CDC and state officials respond

In a phone interview this week, Sharon Watkins, director of the bureau of epidemiology for the Pennsylvania Department of Health said the mold investigation is continuing. At no time has the state or the CDC determined that linens were the most likely cause of the UPMC mold outbreak, she said.

“I don’t know why anyone would say that,” Watkins said, referring to the email that said “the linen vendor is the more likely potential source of mucor.”

UPMC is required to provide the Pennsylvania Department of Health with regular updates concerning the investigation, Pennsylvania Department of Health spokeswoman April Hutcheson said.

Since May 2016, the Pennsylvania health department has been “in constant consultation with the CDC on this issue, including epidemiological evaluation of new information, a site visit, and current review of system-wide UPMC data,” Hutcheson told CNN in a statement when asked about the emails.

“There is no evidence to indicate an ongoing outbreak at this time; however, the state health department is in the process of reviewing additional information as part of the ongoing investigation.”

The UPMC hospital system mold outbreak began in October 2014. By September 2015, four patients had died of fungal infections at UPMC Presbyterian and Montefiore hospitals. By that time, the transplant ICU at Presbyterian had temporarily closed.

In September 2015, while the Presbyterian transplant ICU was closed, the CDC investigated possible sources of the mold outbreak. The results of the investigation were published in the May 2016 Morbidity and Mortality Weekly Report. Investigators said that the fatal infections were not attributed to the mold-covered linens, but rather to ventilation that may have allowed dust and mold spores to enter the hospital rooms.

The CDC maintains that conclusion despite what the newly uncovered emails say, Skinner said. The CDC findings were not addressed in the recently released emails.

In May 2016, Pennsylvania Governor Tom Wolf again requested the CDC consult with the state health department and UPMC because a fifth fungal infection recipient had been identified in the Presbyterian ICU, CDC spokesperson Tom Skinner told CNN when asked about the content of the emails. Wolf’s press secretary, J.J. Abbott, confirmed the request in an email to CNN.

That additional patient was Daniel Krieg, a kidney transplant patient who died in July 2016. UPMC medical reports show Krieg had fungal pneumonia and that fungal-infected sections of his left lung were removed. A CDC representative returned to UPMC on June 22, 2016, with officials from the state and county departments of health to discuss the outbreak and Krieg’s case, Skinner told CNN on Monday.

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An agenda in the newly revealed emails said health officials were to discuss laundry processes at Presbyterian, Montefiore, and Shadyside hospitals at the June 22, 2016 CDC visit.

The day before that visit, an June 21, 2016, email sent by Brink also said that UPMC was working with the linen vendor to “improve their product.” The email also said the hospital system was “aggressively pursuing” an alternative linen solution for all transplant patients in the ICU at Presbyterian hospital.

UPMC said in a January 2016 statement that high-risk transplant patients would receive linens with a lower bacterial count going forward. Hospital linens are required to be “hygienically clean,” according to the Healthcare Laundry Accreditation Council. (PDF) That means linens are not sterile, but in a clean state, free of pathogens in sufficient numbers to minimize risk of infection, and the clean textiles are not inadvertently contaminated before use, according to the CDC.

“Despite the lack of a definitive source, UPMC still went above and beyond state and federal recommendations in order to implement changes to protect our patients. One of the many changes includes the provision of specially treated bioburden-reduced linens to our highest risk transplant patients,” UPMC spokeswoman Hydzik told CNN previously.

How paralyzed man regained hand movements

The early stage research has been tested in a lab with just one patient so far, yet someday it may change the lives of many with spinal cord injuries, said lead author Abidemi Bolu Ajiboye, an assistant professor at Case Western Reserve University.

Even though the system would not become immediately available to patients, Ajiboye believes that all the technical hurdles can be overcome within five to 10 years. “We actually have a handle on everything that we need. There are no significant novel discoveries we need to make for the system,” he said.

Ajiboye said that what makes this achievement unique is not the technology, but the patient. Unlike any previous experiments, a man who is nearly completely paralyzed — or tetraplegic — regained his ability to reach and grasp by virtue of a neuroprosthetic.

Cycling accident

Bill Kochevar, a resident of Cleveland, injured his spinal cord in 2006 prior to enrolling in the study.

“It was a bicycling accident,” said Ajiboye, who explained that Kochevar, 53, was doing a 150-mile bicycle ride on a rainy day. “He was following a mail truck and the mail truck stopped and he ended up running into the back of the truck,” said Ajiboye. As a result, Kochevar has paralysis below the shoulders.

“So he can’t walk, he can’t move his arms, he can’t move his hands,” said Ajiboye.

While the American Spinal Injury Association classifies him at the most disabled level of paralysis, Kochevar is capable of both speaking and moving his head. Prior to enrolling in the study, he often used head tracking software technology that relied on him moving his head to move a cursor on a screen. “But he had no ability to do any sort of functional activities,” said Ajiboye.

Kochevar underwent two surgeries fitting him with the neuroprosthetic. The first operation on December 1, 2014, implanted the brain computer interface, or BCI, in the region of Kochevar brain that is responsible for hand movement, called the motor cortex.

The BCI is an electrode array which penetrates the brain between one to one and a half millimeters, said Ajiboye.

Next, Kochevar underwent a second surgery to implant 36 muscle stimulating electrodes into his upper and lower arm. Known as functional electrical stimulation or FES, these electrodes are key to restoring movement in his finger and thumb, wrist, elbow and shoulders.

The Cleveland Functional Electrical Stimulation Center, of which Ajiboye is a part, first developed electrical stimulation technology for reanimating paralyzed function nearly 30 years ago. As Ajiboye explained, the technology is similar to a pacemaker in that it applies electrical stimulation to the muscles in order to stir movement.

After the separate technologies were implanted, the researchers connected Kochevar’s brain-computer interface to the electrical stimulators in his arm. At this point, Kochevar began learning how to use his neuroprosthetic and that process started with a virtual arm.

“We had him watch the virtual arm move, he attempted to move his arm in the same way, and that elicited some patterns of cortical activity — some patterns of electrical neural activity,” said Ajiboye.

This electrical activity was recorded and based on this recording, Ajiboye and his colleagues created a “neural decoder” — an algorithm specific to Kochevar — that could translate the patterns of Kochevar’s recorded brain signals into commands for the electrodes in his arm.

“Then we had him use our algorithm to control the virtual arm on the screen just using his brain signals,” said Ajiboye. “Very early on he could hit the target with 95 to 100% accuracy.” This ‘virtual’ step in the process helped Ajiboye and his colleagues refine the algorithm.

“Then, finally, we basically do the same thing with his actual arm. We manually move his arm, and we have him imagine he’s doing it,” said Ajiboye. Kochevar is then able to move his arm on his own by thinking the command (and so generating once again the same brain pattern when he imagined moving his arm) and this is then actuated through electrical stimulation.

Essentially, the technology circumvents the spinal injury feeding the electrical stimulation of his brain through wires to the electrodes in his arm.

After mastering simple movements, Kochevar was tested on day-to-day tasks, including drinking a cup of coffee and feeding himself. In all of these, Kochevar was successful.

“There were no significant adverse events, the system is safe, so as far as the clinical trial endpoint goes, he has met those,” said Ajiboye.

“Now he has opted voluntarily to continue working as a participant in our study for at least another five years,” said Ajiboye. Kochevar hopes to experience the benefits of the technology for himself while also seeing it advance to the point of becoming available for other people with spinal cord injuries, according to Ajiboye.

CNN attempted to contact Kochevar for comment.

‘Encouraging’ results

A previous unrelated study showed paraplegic people with spinal cord injuries using brain-machine interfaces to gain control of their brain activity and stimulate movement in their legs. A separate study used a brain-spine interface to communicate nerve signals and helped paralyzed monkeys to regain movement.
According to Andrew Schwartz, a professor of neurobiology at the University of Pittsburgh, the new study “shows the potential that [a brain-machine interface] can be used to reanimate a limb.” Schwartz was uninvolved with the current study.

While the “generated movements were somewhat rudimentary” with a rather limited range of action, “the attempt to use multiple degrees of freedom was encouraging,” said Schwartz.

“I liked the idea that movements were decoded first and then transformed to muscle activations,” he added. “For real movements in the real world, this transformation will be very difficult to calculate and that is where real science will be needed.”

In an editorial published alongside the study, Steve I. Perlmutter, an associate professor at University of Washington in Seattle, said the research is “groundbreaking as the first report of a person executing functional, multijoint movements of a paralysed limb with a motor neuroprosthetic. However, this treatment is not nearly ready for use outside the lab.”

Similar to Schwartz, Perlmutter noted that Kochevar’s movements were “rough and slow” and had limited range due to the necessary motorized device.

“Stimulation of nerves or the spinal cord, rather than muscles, and more sophisticated stimulation technology may provide substantial improvements,” wrote Perlmutter.

“The algorithms for this type of brain computer interface are very important, but there are many other factors that are also critical, including the ability to measure brain signals reliably for long periods of time,” Perlmutter said in an email. He added another critical issue is execution of movement.

Hurdles that all motor neuroprostheses must overcome have yet to be addressed, noted Perlmutter, including “development of devices that are small enough, robust enough, and cheap enough to be fully mobile and widely available.”

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Ajiboye acknowledges the need for smaller technologies. Still, he said, his new study differs from previous work done in the field. Although other labs have worked with non-human primates or partially paralyzed participants, his study helped someone who is completely paralyzed.

“This is an exponentially harder problem,” said Ajiboye. “Our study is the first in the world, to my knowledge, to take someone paralyzed and give him the ability to both reach and grasp objects… so that he can regain the ability to perform functional activities of daily living.”

One other way the new study differs from previous research is Ajiboye and his colleagues built their neuroprosthetic from separate technologies, each of which had already been proven viable. This translates to the entire system, when refined, more easily gaining approval and becoming available to patients.

“The goal is to do much more than a cool science experiment,” said Ajiboye.

Meet the major players in the Trump-Russia saga

It is just the latest development in the ever-evolving saga about alleged Russian tampering in the 2016 presidential election. CNN has compiled a list of the growing and diverse cast characters at the start of a critical week of hearings for Senate investigators looking into Russia’s actions and its possible ties to Trump associates.

Several US lawmakers and agency heads have emerged as visible, and at times controversial, figures in the investigations into connections between individuals in Trump’s orbit and Russian hacking of Democratic Party groups including the Democratic National Committee and Clinton campaign adviser John Podesta.

Mike Rogers — Late last year, Rogers was simultaneously a candidate to be promoted to Director of National Intelligence under President-elect Trump and on the hot seat to be fired as director of the National Security Agency by then-President Barack Obama. Eventually, Rogers remained in his role as the director of the NSA under Trump and now finds himself among those agency heads testifying before Congress as an authority on cybersecurity as it relates to hacks by suspect Russian-relate groups.

Rogers played a key role in last week’s House hearing with Comey when he joined the FBI director in refuting Trump’s claim that Obama had had his phones tapped during the campaign. He in particular batted down the notion that the Obama administration requested that the British eavesdrop on Trump, an unfounded assertion made on Fox News cited by the Trump White House.

Sally Yates — A holdover from the Obama administration, the most memorable moment of Yates’ short tenure as acting Attorney General may have been her firing in the early days of the Trump administration after she refused to implement the President’s orders barring travelers from seven Muslim-majority countries.

Yates also briefed Trump’s White House counsel on former national security adviser Michael Flynn’s meeting with Russian ambassador Sergey Kislyak, communications that ultimately led to Flynn’s resignation. Her scheduled testimony before the House Intelligence Committee on ties between Russian agents and Trump campaign officials was abruptly cancelled by committee Chairman Devin Nunes. The White House rejected allegations that it had sought to prevent Yates from testifying.
James Clapper — The director of national intelligence under Obama has never been shy in offering criticism of Trump, clashing with him over the latter’s public disparagement of intelligence officers, wiretapping allegations and views on Russian hacking. Clapper, along with Comey and then-CIA Director John Brennan, briefed Trump on Russian hacking during the election campaign just hours after the President-elect doubled down on his dismissal of the threat as an artificial and politically driven controversy, calling it a “witch hunt.” He has also had been invited to testify by Congress.

Members of Congress

Devin Nunes — The man charged with leading the House’s investigation into possible connections between Trump associates and Russia’s hacking of the 2016 election has been a particular focus of controversy in recent weeks. Nunes worked on Trump’s transition team, publically supported Flynn just hours before his resignation as national security adviser and downplaying Trump’s wiretapping allegations against Obama by suggesting they shouldn’t be taken literally.

Nunes particularly provoked Democrats after he disclosed evidence to the press and White House — before informing Democrats on his committee — that the Trump team’s communications may have been picked up in “incidental” collections by US surveillance of conversations with foreign nationals who were being lawfully monitored. That was seen as a move to bolster Trump’s claims of having been wiretapped. The news Monday that Nunes met his source on White House grounds the day before he briefed Trump sparked the latest round of partisan fighting and has left investigators unable to continue right now. Now, Nunes is facing calls to step down as chairman amid questions as to whether he can conduct an impartial investigation. He told CNN Tuesday morning, however, that he was “moving forward” with the investigation.

Adam Schiff — The Democratic “yin” to Nunes’ Republican “yang,” Schiff is his party’s most senior member on the House Intelligence Committee and has been one of the most visible lawmakers on the Russia investigation. Though the committee has historically been one of the more discreet on Capitol Hill, Schiff hasn’t held back his criticism of Trump or, increasingly, the committee chairman. On Monday, Schiff called on Nunes to recuse himself from the investigation in a stunning split between the two top investigators of a committee with a reputation for bipartisanship. Schiff has repeatedly maintained he’s seen additional evidence that is more than circumstantial proof of collusion between Trump aides and Russian entities.

Elijah Cummings — The representative from Maryland is the ranking Democrat on the House Oversight Committee. Cummings was one of the first lawmakers to call for an investigation into Russian meddling in the US election. Cummings wrote a letter to committee chairman Rep. Jason Chaffetz in November 2016 calling for a bipartisan commission, similar to the one that investigated the 9/11 attacks, and the Democratic effort to have an independent investigation is only gathering steam as the acrimony on Capitol Hill rises.

Cummings has also gone beyond calls for Nunes to recuse himself, suggesting he be investigated after his comments disclosing the surveillance that may have picked up conversation of Trump associates. And he has also sharply denounced Flynn, brandishing emails that show the former national security adviser was paid by Russian entities for a trip there during the campaign, raising legal and regulatory questions.

Richard Burr NC Senate

Richard Burr NC Senate

Richard Burr NC Senate

Richard Burr — The North Carolina Republican and chairman of the Senate Intelligence committee is leading a separate investigation into Russian efforts to tamper with the US election. So far it has been a low-key process, as he’s stayed out of the limelight while interviewing witnesses in private. Some of that will change Thursday, when the Senate Intelligence Committee hosts its first public hearing for its Russia investigation.

Trump associates

Investigations by the FBI and congressional committees have included several aides to the Trump campaign and their communication with key foreign entities and, in some cases, Russian operatives. Others have cropped up in headlines because of their dealings with the longtime US adversary. Several of these individuals have volunteered to testify before House and Senate Intelligence Committees in recent days to clear up questions about their actions and associations.

Michael Flynn — Flynn has courted controversy since before he became an early supporter of Trump’s campaign. In 2014, he was pushed out as director of the Defense Intelligence Agency in Obama’s Pentagon. Flynn said it was because he raised alarm bells on Islamic terrorism, but four US officials serving at time told CNN it was because of his contentious management style.

His reputation for outspokenness and criticizing Washington figures led to raised eyebrows inside the Beltway when Trump tapped him as national security adviser. His tenure in any case didn’t last long, as he resigned after acknowledging that he misled Vice President Mike Pence about the nature of his communications with the Russian ambassador in Washington, Sergey Kislyak. He had initially denied that they had discussed sanctions recently imposed by the Obama administration. It is illegal for unauthorized private citizens to negotiate with foreign governments on behalf of the US, though the FBI has said that it has no intention of bringing charges against Flynn. At the time, Flynn did not hold a public office in the US government which technically qualifies him as a private citizen

His financial ties with Russia and other foreign countries have also attracted attention, including the emails obtained by Cummings showing that he was paid by a state-run Russian TV outlet from which he had originally denied receiving funds.

Paul Manafort — A Republican strategist and longtime Washington operator, Manafort joined Trump’s campaign team last spring and was elevated after campaign manager Corey Lewandowski was fired in June. But with just under three months to go until the presidential election, Manafort resigned amid questions over his campaign role and extensive lobbying history overseas, particularly in Ukraine, where he represented pro-Russian interests.
Manafort’s connections to Russia faced fresh scrutiny last month after current and former US officials told CNN that high-level Trump campaign advisers, including Manafort, regularly communicated with Russians known to US intelligence. Manafort called the allegation “100% not true” and said he didn’t “remember talking to any Russian officials, ever.”

Jared Kushner — The 36-year-old businessman-turned-political operative played a crucial role in his father-in-law’s presidential campaign and has carved out a role for himself as one of Trump’s key White House aides. After amassing billions of dollars in properties over his decade in the New York real estate market, he now finds himself frequently assisting the President in matters of foreign policy.

That has led to questions in certain arenas, including a recently disclosed meeting he held in December with a Russian banker appointed by President Vladimir Putin. The White House maintains that Kushner met with the banker in his role as a Trump adviser while the bank said it met with Kushner as a private developer.

Kushner has volunteered to testify before senators because of his role in arranging meetings between top campaign advisers and Kislyak, the Russian ambassador.

Carter Page — Page worked for seven years as an investment banker at Merrill Lynch, which his biography said took him to London, New York and Moscow for three years in the mid-2000s, before Trump last year listed him as a foreign policy adviser in response to a question from The Washington Post.

Page has regularly espoused views at odds with much of the foreign policy community in Washington, in particular questioning the US approach toward Russia and called for warmer relations between the two countries.

His reported meeting with Kislyak during the Republican convention in Cleveland is one of his interactions with Russian officials that has caught the attention of the FBI. Page has denied any wrongdoing and volunteered Friday to speak to the House Intelligence Committee about his role in Trump’s campaign. Page, who the White House has said was only loosely connected to the Trump campaign, emphasized last week that he was not a campaign insider.

J.D. Gordon — A former Pentagon spokesman under Defense Secretaries Donald Rumsfeld and Robert Gates, Gordon contributed to a variety of media outlets before working as a national security adviser to the Trump campaign.

Gordon disclosed earlier this month that he was among the Trump advisers who had met with Kislyak during the Republican National Convention in Cleveland in July. Gordon told CNN that he told Kislyak that he would like to improve relations with Russia. Gordon added that at no time did any inappropriate chatter come up about colluding with the Russians to aid the Trump campaign.
Roger Stone — The eccentric former Trump adviser and self-described, master of political dark arts has been labeled as the “dirty trickster” of delegate fights. He has worked with the campaigns of Richard Nixon, George H. W. Bush and Ronald Reagan.

Stone repeatedly claimed throughout the final months of the 2016 campaign that he had backchannel communications with WikiLeaks founder Julian Assange and that he knew of the group’s forthcoming document dumps, which disseminated the materials hacked from the Democrats. Later, Stone walked back those tweets. His attorney told CNN on Friday that he is willing to speak to the House Intelligence Committee — preferably in public — but maintains he has done nothing wrong. Wikileaks also denies any connection with Stone.

Roger Stone also has been forced to defend contacts with hacker Guccier 2.0 on Twitter. While Stone said his messages to the hacker alias are of no consequence, he is the first person in Trump’s orbit to have acknowledged any contact with a hacker — not to mention one that claimed responsibility for hacking the DNC.
Michael Cohen — Trump’s personal lawyer has been a staunch defender of his client, often serving as a media surrogate during the campaign. During a CNN interview in February, Ukrainian lawmaker Andrii Artemenko said he had discussed a pro-Russian peace plan for Ukraine with Cohen over dinner in January. Ukraine would vehemently oppose the idea that the White House would consider formalizing Russian control of Crimea. Cohen told CNN that they never discussed a peace plan and the White House has flatly denied any knowledge of the proposal.

Foreign connections

Connections between Trump campaign aides and notable foreigners have fueled suspicions of possible coordination with Russia. Specifically, the US officials told CNN last week that it has information that indicates Trump associates communicated with suspected Russian operatives to possibly coordinate the release of information damaging to Hillary Clinton’s campaign.
Sergey Kislyak — The Russian ambassador to the US is seemingly ubiquitous around town, having gained extensive experience during a career spanning both the Soviet and Russian Federation eras. Not only did the veteran diplomat meet multiple times with Flynn, drawing scrutiny, but his meetings with then-Sen. Jeff Sessions led to the attorney general recusing himself from any potential investigations.

Kislyak has also held several meetings — or at least photo-ops — with Democrats. House Minority Leader Nancy Pelosi (who has joined the calls for Nunes to recuse himself) claimed to have never met with Kislyak, but a photo surfaced showing the two individuals in the same room. Current and former US intelligence officials TELL CNN that Kislyak is a top spy and recruiter of spies, an accusation that Russian officials have dismissed.

Julian Assange — The founder of Wikileaks, the self-styled “radical transparency” organization with the stated goal of exposing the secrets of the powerful, Assange has cast a wide, blurry shadow over the center of US politics from his seclusion in the Ecuadorian Embassy in London, where he remains holed up to avoid facing sexual assault charges in Sweden and a potential extradition to the United States.

Assange spearheaded the release of nearly 20,000 internal DNC emails last July, which US intelligence bodies unanimously concluded were hacked by the Russians. WikiLeaks also began to serially release emails from Podesta, the Clinton campaign chairman, in October. WikiLeaks has denied that Russia was the source for its disclosures, and the Russian government has emphatically denied any connection with the theft as well.
Guccifer 2.0 — The hacker otherwise known as “Guccifer 2.0” burst into the national conversation after claiming responsibility for a hack of the Democratic National Committee last year. US officials believe with “high confidence” that “Guccifer 2.0” was actually a front for Russian military intelligence and was part of the effort to influence America’s elections.

Roger Stone has been forced to defend contacts with the online persona via Twitter. While Stone said his messages to the hacker alias are of no consequence, he is the first person in Trump’s orbit to have acknowledged any contact with a hacker — not to mention one that claimed responsibility for hacking the DNC.

Christopher Steele — A former officer with MI6, the UK’s foreign intelligence service, Steele compiled a dossier of unsubstantiated allegations related to Trump’s personal and business ties to Russia before he became president. Steele initially had been hired by a Washington research firm working on behalf of Trump’s political opponents — initially in the Republican primary and then later Democrats.

The FBI obtained a version of Steele’s dossier last summer and investigators compared it to some of their own work related to Russia’s attempts to influence the US election.

His file contained claims that Russian operatives had compromising personal and financial information about Trump. Trump has consistently denied the claims, dismissing them as “phony” in January, though Schiff and others drew on some of them in the Comey-Rogers hearing last week. US investigators said they have corroborated some of the communications in the dossier, but CNN has not been able to verify many of the specific allegations in the documents.

CNN’s Dylan Byers, Marshall Cohen, Thomas Frank, Jeremy Diamond, Barbara Starr, Pamela Brown, Evan Perez, Jim Sciutto, Gloria Borger and Manu Raju contributed to this report.

Meet the major players in the Trump-Russia saga

It is just the latest development in the ever-evolving saga about alleged Russian tampering in the 2016 presidential election. CNN has compiled a list of the growing and diverse cast characters at the start of a critical week of hearings for Senate investigators looking into Russia’s actions and its possible ties to Trump associates.

Several US lawmakers and agency heads have emerged as visible, and at times controversial, figures in the investigations into connections between individuals in Trump’s orbit and Russian hacking of Democratic Party groups including the Democratic National Committee and Clinton campaign adviser John Podesta.

Mike Rogers — Late last year, Rogers was simultaneously a candidate to be promoted to Director of National Intelligence under President-elect Trump and on the hot seat to be fired as director of the National Security Agency by then-President Barack Obama. Eventually, Rogers remained in his role as the director of the NSA under Trump and now finds himself among those agency heads testifying before Congress as an authority on cybersecurity as it relates to hacks by suspect Russian-relate groups.

Rogers played a key role in last week’s House hearing with Comey when he joined the FBI director in refuting Trump’s claim that Obama had had his phones tapped during the campaign. He in particular batted down the notion that the Obama administration requested that the British eavesdrop on Trump, an unfounded assertion made on Fox News cited by the Trump White House.

Sally Yates — A holdover from the Obama administration, the most memorable moment of Yates’ short tenure as acting Attorney General may have been her firing in the early days of the Trump administration after she refused to implement the President’s orders barring travelers from seven Muslim-majority countries.

Yates also briefed Trump’s White House counsel on former national security adviser Michael Flynn’s meeting with Russian ambassador Sergey Kislyak, communications that ultimately led to Flynn’s resignation. Her scheduled testimony before the House Intelligence Committee on ties between Russian agents and Trump campaign officials was abruptly cancelled by committee Chairman Devin Nunes. The White House rejected allegations that it had sought to prevent Yates from testifying.
James Clapper — The director of national intelligence under Obama has never been shy in offering criticism of Trump, clashing with him over the latter’s public disparagement of intelligence officers, wiretapping allegations and views on Russian hacking. Clapper, along with Comey and then-CIA Director John Brennan, briefed Trump on Russian hacking during the election campaign just hours after the President-elect doubled down on his dismissal of the threat as an artificial and politically driven controversy, calling it a “witch hunt.” He has also had been invited to testify by Congress.

Members of Congress

Devin Nunes — The man charged with leading the House’s investigation into possible connections between Trump associates and Russia’s hacking of the 2016 election has been a particular focus of controversy in recent weeks. Nunes worked on Trump’s transition team, publically supported Flynn just hours before his resignation as national security adviser and downplaying Trump’s wiretapping allegations against Obama by suggesting they shouldn’t be taken literally.

Nunes particularly provoked Democrats after he disclosed evidence to the press and White House — before informing Democrats on his committee — that the Trump team’s communications may have been picked up in “incidental” collections by US surveillance of conversations with foreign nationals who were being lawfully monitored. That was seen as a move to bolster Trump’s claims of having been wiretapped. The news Monday that Nunes met his source on White House grounds the day before he briefed Trump sparked the latest round of partisan fighting and has left investigators unable to continue right now. Now, Nunes is facing calls to step down as chairman amid questions as to whether he can conduct an impartial investigation. He told CNN Tuesday morning, however, that he was “moving forward” with the investigation.

Adam Schiff — The Democratic “yin” to Nunes’ Republican “yang,” Schiff is his party’s most senior member on the House Intelligence Committee and has been one of the most visible lawmakers on the Russia investigation. Though the committee has historically been one of the more discreet on Capitol Hill, Schiff hasn’t held back his criticism of Trump or, increasingly, the committee chairman. On Monday, Schiff called on Nunes to recuse himself from the investigation in a stunning split between the two top investigators of a committee with a reputation for bipartisanship. Schiff has repeatedly maintained he’s seen additional evidence that is more than circumstantial proof of collusion between Trump aides and Russian entities.

Elijah Cummings — The representative from Maryland is the ranking Democrat on the House Oversight Committee. Cummings was one of the first lawmakers to call for an investigation into Russian meddling in the US election. Cummings wrote a letter to committee chairman Rep. Jason Chaffetz in November 2016 calling for a bipartisan commission, similar to the one that investigated the 9/11 attacks, and the Democratic effort to have an independent investigation is only gathering steam as the acrimony on Capitol Hill rises.

Cummings has also gone beyond calls for Nunes to recuse himself, suggesting he be investigated after his comments disclosing the surveillance that may have picked up conversation of Trump associates. And he has also sharply denounced Flynn, brandishing emails that show the former national security adviser was paid by Russian entities for a trip there during the campaign, raising legal and regulatory questions.

Richard Burr NC Senate

Richard Burr — The North Carolina Republican and chairman of the Senate Intelligence committee is leading a separate investigation into Russian efforts to tamper with the US election. So far it has been a low-key process, as he’s stayed out of the limelight while interviewing witnesses in private. Some of that will change Thursday, when the Senate Intelligence Committee hosts its first public hearing for its Russia investigation.

Trump associates

Investigations by the FBI and congressional committees have included several aides to the Trump campaign and their communication with key foreign entities and, in some cases, Russian operatives. Others have cropped up in headlines because of their dealings with the longtime US adversary. Several of these individuals have volunteered to testify before House and Senate Intelligence Committees in recent days to clear up questions about their actions and associations.

Michael Flynn — Flynn has courted controversy since before he became an early supporter of Trump’s campaign. In 2014, he was pushed out as director of the Defense Intelligence Agency in Obama’s Pentagon. Flynn said it was because he raised alarm bells on Islamic terrorism, but four US officials serving at time told CNN it was because of his contentious management style.

His reputation for outspokenness and criticizing Washington figures led to raised eyebrows inside the Beltway when Trump tapped him as national security adviser. His tenure in any case didn’t last long, as he resigned after acknowledging that he misled Vice President Mike Pence about the nature of his communications with the Russian ambassador in Washington, Sergey Kislyak. He had initially denied that they had discussed sanctions recently imposed by the Obama administration. It is illegal for unauthorized private citizens to negotiate with foreign governments on behalf of the US, though the FBI has said that it has no intention of bringing charges against Flynn. At the time, Flynn did not hold a public office in the US government which technically qualifies him as a private citizen

His financial ties with Russia and other foreign countries have also attracted attention, including the emails obtained by Cummings showing that he was paid by a state-run Russian TV outlet from which he had originally denied receiving funds.

Paul Manafort — A Republican strategist and longtime Washington operator, Manafort joined Trump’s campaign team last spring and was elevated after campaign manager Corey Lewandowski was fired in June. But with just under three months to go until the presidential election, Manafort resigned amid questions over his campaign role and extensive lobbying history overseas, particularly in Ukraine, where he represented pro-Russian interests.
Manafort’s connections to Russia faced fresh scrutiny last month after current and former US officials told CNN that high-level Trump campaign advisers, including Manafort, regularly communicated with Russians known to US intelligence. Manafort called the allegation “100% not true” and said he didn’t “remember talking to any Russian officials, ever.”

Jared Kushner — The 36-year-old businessman-turned-political operative played a crucial role in his father-in-law’s presidential campaign and has carved out a role for himself as one of Trump’s key White House aides. After amassing billions of dollars in properties over his decade in the New York real estate market, he now finds himself frequently assisting the President in matters of foreign policy.

That has led to questions in certain arenas, including a recently disclosed meeting he held in December with a Russian banker appointed by President Vladimir Putin. The White House maintains that Kushner met with the banker in his role as a Trump adviser while the bank said it met with Kushner as a private developer.

Kushner has volunteered to testify before senators because of his role in arranging meetings between top campaign advisers and Kislyak, the Russian ambassador.

Carter Page — Page worked for seven years as an investment banker at Merrill Lynch, which his biography said took him to London, New York and Moscow for three years in the mid-2000s, before Trump last year listed him as a foreign policy adviser in response to a question from The Washington Post.

Page has regularly espoused views at odds with much of the foreign policy community in Washington, in particular questioning the US approach toward Russia and called for warmer relations between the two countries.

His reported meeting with Kislyak during the Republican convention in Cleveland is one of his interactions with Russian officials that has caught the attention of the FBI. Page has denied any wrongdoing and volunteered Friday to speak to the House Intelligence Committee about his role in Trump’s campaign. Page, who the White House has said was only loosely connected to the Trump campaign, emphasized last week that he was not a campaign insider.

J.D. Gordon — A former Pentagon spokesman under Defense Secretaries Donald Rumsfeld and Robert Gates, Gordon contributed to a variety of media outlets before working as a national security adviser to the Trump campaign.

Gordon disclosed earlier this month that he was among the Trump advisers who had met with Kislyak during the Republican National Convention in Cleveland in July. Gordon told CNN that he told Kislyak that he would like to improve relations with Russia. Gordon added that at no time did any inappropriate chatter come up about colluding with the Russians to aid the Trump campaign.
Roger Stone — The eccentric former Trump adviser and self-described, master of political dark arts has been labeled as the “dirty trickster” of delegate fights. He has worked with the campaigns of Richard Nixon, George H. W. Bush and Ronald Reagan.

Stone repeatedly claimed throughout the final months of the 2016 campaign that he had backchannel communications with WikiLeaks founder Julian Assange and that he knew of the group’s forthcoming document dumps, which disseminated the materials hacked from the Democrats. Later, Stone walked back those tweets. His attorney told CNN on Friday that he is willing to speak to the House Intelligence Committee — preferably in public — but maintains he has done nothing wrong. Wikileaks also denies any connection with Stone.

Roger Stone also has been forced to defend contacts with hacker Guccier 2.0 on Twitter. While Stone said his messages to the hacker alias are of no consequence, he is the first person in Trump’s orbit to have acknowledged any contact with a hacker — not to mention one that claimed responsibility for hacking the DNC.
Michael Cohen — Trump’s personal lawyer has been a staunch defender of his client, often serving as a media surrogate during the campaign. During a CNN interview in February, Ukrainian lawmaker Andrii Artemenko said he had discussed a pro-Russian peace plan for Ukraine with Cohen over dinner in January. Ukraine would vehemently oppose the idea that the White House would consider formalizing Russian control of Crimea. Cohen told CNN that they never discussed a peace plan and the White House has flatly denied any knowledge of the proposal.

Foreign connections

Connections between Trump campaign aides and notable foreigners have fueled suspicions of possible coordination with Russia. Specifically, the US officials told CNN last week that it has information that indicates Trump associates communicated with suspected Russian operatives to possibly coordinate the release of information damaging to Hillary Clinton’s campaign.
Sergey Kislyak — The Russian ambassador to the US is seemingly ubiquitous around town, having gained extensive experience during a career spanning both the Soviet and Russian Federation eras. Not only did the veteran diplomat meet multiple times with Flynn, drawing scrutiny, but his meetings with then-Sen. Jeff Sessions led to the attorney general recusing himself from any potential investigations.

Kislyak has also held several meetings — or at least photo-ops — with Democrats. House Minority Leader Nancy Pelosi (who has joined the calls for Nunes to recuse himself) claimed to have never met with Kislyak, but a photo surfaced showing the two individuals in the same room. Current and former US intelligence officials TELL CNN that Kislyak is a top spy and recruiter of spies, an accusation that Russian officials have dismissed.

Julian Assange — The founder of Wikileaks, the self-styled “radical transparency” organization with the stated goal of exposing the secrets of the powerful, Assange has cast a wide, blurry shadow over the center of US politics from his seclusion in the Ecuadorian Embassy in London, where he remains holed up to avoid facing sexual assault charges in Sweden and a potential extradition to the United States.

Assange spearheaded the release of nearly 20,000 internal DNC emails last July, which US intelligence bodies unanimously concluded were hacked by the Russians. WikiLeaks also began to serially release emails from Podesta, the Clinton campaign chairman, in October. WikiLeaks has denied that Russia was the source for its disclosures, and the Russian government has emphatically denied any connection with the theft as well.
Guccifer 2.0 — The hacker otherwise known as “Guccifer 2.0” burst into the national conversation after claiming responsibility for a hack of the Democratic National Committee last year. US officials believe with “high confidence” that “Guccifer 2.0” was actually a front for Russian military intelligence and was part of the effort to influence America’s elections.

Roger Stone has been forced to defend contacts with the online persona via Twitter. While Stone said his messages to the hacker alias are of no consequence, he is the first person in Trump’s orbit to have acknowledged any contact with a hacker — not to mention one that claimed responsibility for hacking the DNC.

Christopher Steele — A former officer with MI6, the UK’s foreign intelligence service, Steele compiled a dossier of unsubstantiated allegations related to Trump’s personal and business ties to Russia before he became president. Steele initially had been hired by a Washington research firm working on behalf of Trump’s political opponents — initially in the Republican primary and then later Democrats.

The FBI obtained a version of Steele’s dossier last summer and investigators compared it to some of their own work related to Russia’s attempts to influence the US election.

His file contained claims that Russian operatives had compromising personal and financial information about Trump. Trump has consistently denied the claims, dismissing them as “phony” in January, though Schiff and others drew on some of them in the Comey-Rogers hearing last week. US investigators said they have corroborated some of the communications in the dossier, but CNN has not been able to verify many of the specific allegations in the documents.

CNN’s Dylan Byers, Marshall Cohen, Thomas Frank, Jeremy Diamond, Barbara Starr, Pamela Brown, Evan Perez, Jim Sciutto, Gloria Borger and Manu Raju contributed to this report.