Postdecision Evidence Integration and Depressive Symptoms

Background: Metacognition, or the ability to reflect on one’s own thoughts, may be important in the development of depressive symptoms. Recent work has reported that depressive symptoms were associated with lower metacognitive bias (overall confidence) during perceptual decision making and a trend toward a positive association with metacognitive sensitivity (the ability to discriminate correct and incorrect decisions). Here, we extended this work, investigating whether confidence judgments are more malleable in individuals experiencing depressive symptoms. We hypothesized that depressive symptoms would be associated with greater adjustment of confidence in light of new evidence presented after a perceptual decision had been made. // Methods: Participants (N = 416) were recruited via Amazon Mechanical Turk. Metacognitive confidence was assessed through two perceptual decision-making tasks. In both tasks, participants made a decision about which of two squares contained more dots. In the first task, participants rated their confidence immediately following the decision, whereas in the second task, participants observed new evidence (always in the same direction as initial evidence) before rating their confidence. Participants also completed questionnaires measuring depressive symptoms and self-esteem. // Analysis: Metacognitive bias was calculated as overall mean confidence, whereas metacognitive sensitivity was calculated using meta-d’ (a response-bias free measure of how closely confidence tracks task performance) in the first task. Postdecision evidence integration (PDEI) was defined as the change in confidence following postdecision evidence on the second task. // Results: Participants with more depressive symptoms made greater confidence adjustments (i.e., greater PDEI) in light of new evidence (β = 0.119, p = 0.045), confirming our main hypothesis. We also observed that lower overall confidence was associated with greater depressive symptoms, although this narrowly missed statistical significance (β = -0.099, p = 0.056), and we did not find an association between metacognitive sensitivity (meta-d’) and depressive symptoms. Notably, self-esteem was robustly associated with overall confidence (β = 0.203, p < 0.001), which remained significant when controlling for depressive symptoms. // Conclusions: We found that individuals with depressive symptoms were more influenced by postdecisional evidence, adjusting their confidence more in light of new evidence. Individuals with low self-esteem were less confident about their initial decisions. This study should be replicated in a clinically depressed sample

Acute high-intensity interval running increases markers of damage and permeability but not gastrointestinal symptoms.

Purpose: To investigate the effects of high-intensity interval (HIIT) running on markers of gastrointestinal (GI) damage and permeability alongside subjective symptoms of GI discomfort. Methods: Eleven male runners completed an acute bout of HIIT (eighteen 400 m runs at 120%O2max ) where markers of GI permeability, intestinal damage and GI discomfort symptoms were assessed and compared with resting conditions. Results: Compared to rest, HIIT significantly increased serum lactulose:rhamnose ratio (0.051 ± 0.016 vs. 0.031 ± 0.021, p = 0.0047; 95% CI = 0.006 - 0.036) and sucrose concentrations (0.388 ± 0.217 vs 0.137 ± 0.148 mg.l-1; p < 0.001; 95% CI = 0.152 - 0.350). In contrast, urinary lactulose:rhamnose (0.032 ± 0.005 vs 0.030 ± 0.005; p = 0.3; 95% CI = -0.012 - 0.009) or sucrose concentrations (0.169 ± 0.168% vs 0.123 ± 0.120%; p = 0.54; 95% CI = -0.199 - 0.108) did not differ between HIIT and resting conditions. Plasma I-FABP was significantly increased (p < 0.001) during and in the recovery period from HIIT whereas no changes were observed during rest. Mild-symptoms of GI discomfort, were reported immediately- and 24 h post-HIIT, although these symptoms did not correlate to GI permeability or I-FABP. Conclusion Acute HIIT increased GI permeability and intestinal I-FABP release, although these do not correlate with symptoms of GI discomfort. Furthermore, by using serum sampling, we provide data showing that it is possible to detect changes in intestinal permeability that is not observed using urinary sampling over a shorter time-period

Glutamine supplementation reduces markers of intestinal permeability during running in the heat in a dose-dependent manner.

PURPOSE: To examine the dose-response effects of acute glutamine supplementation on markers of gastrointestinal (GI) permeability, damage and, secondary, subjective symptoms of GI discomfort in response to running in the heat. METHODS: Ten recreationally active males completed a total of four exercise trials; a placebo trial and three glutamine trials at 0.25, 0.5 and 0.9 g kg(-1) of fat-free mass (FFM) consumed 2 h before exercise. Each exercise trial consisted of a 60-min treadmill run at 70% of [Formula: see text] in an environmental chamber set at 30 °C. GI permeability was measured using ratio of lactulose to rhamnose (L:R) in serum. Plasma glutamine and intestinal fatty acid binding protein (I-FABP) concentrations were determined pre and post exercise. Subjective GI symptoms were assessed 45 min and 24 h post-exercise. RESULTS: Relative to placebo, L:R was likely lower following 0.25 g kg(-1) (mean difference: - 0.023; ± 0.021) and 0.5 g kg(-1) (- 0.019; ± 0.019) and very likely following 0.9 g kg(- 1) (- 0.034; ± 0.024). GI symptoms were typically low and there was no effect of supplementation. DISCUSSION: Acute oral glutamine consumption attenuates GI permeability relative to placebo even at lower doses of 0.25 g kg(-1), although larger doses may be more effective. It remains unclear if this will lead to reductions in GI symptoms. Athletes competing in the heat may, therefore, benefit from acute glutamine supplementation prior to exercise in order to maintain gastrointestinal integrity

The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: Cluster randomised trial of humour therapy in nursing homes

Objectives: To determine whether humour therapy reduces depression (primary outcome), agitation and behavioural disturbances and improves social engagement and quality-of-life in nursing home residents. Design: The Sydney Multisite Intervention of LaughterBosses and ElderClowns study was a singleblind cluster randomised controlled trial of humour therapy. Setting: 35 Sydney nursing homes. Participants: All eligible residents within geographically defined areas within each nursing home were invited to participate. Intervention: Professional 'ElderClowns' provided 9-12 weekly humour therapy sessions, augmented by resident engagement by trained staff 'LaughterBosses'. Controls received usual care. Measurements: Depression scores on the Cornell Scale for Depression in Dementia, agitation scores on the Cohen-Mansfield Agitation Inventory, behavioural disturbance scores on the Neuropsychiatric Inventory, social engagement scores on the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and self-rated and proxy-rated quality-of-life scores on a health-related quality-of-life tool for dementia, the DEMQOL. All outcomes were measured at the participant level by researchers blind to group assignment. Randomisation: Sites were stratified by size and level of care then assigned to group using a random number generator. Results: Seventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Groups did not differ significantly over time on the primary outcome of depression, or on behavioural disturbances other than agitation, social engagement and quality of life. The secondary outcome of agitation was significantly reduced in the intervention group compared with controls over 26 weeks (time by group interaction adjusted for covariates: p=0.011). The mean difference in change from baseline to 26 weeks in Blom-transformed agitation scores after adjustment for covariates was 0.17 (95% CI 0.004 to 0.34, p=0.045). Conclusions: Humour therapy did not significantly reduce depression but significantly reduced agitation

Anti-müllerian hormone is not associated with cardiometabolic risk factors in adolescent females

&lt;p&gt;Objectives: Epidemiological evidence for associations of Anti-Müllerian hormone (AMH) with cardiometabolic risk factors is lacking. Existing evidence comes from small studies in select adult populations, and findings are conflicting. We aimed to assess whether AMH is associated with cardiometabolic risk factors in a general population of adolescent females.&lt;/p&gt; &lt;p&gt;Methods: AMH, fasting insulin, glucose, HDLc, LDLc, triglycerides and C-reactive protein (CRP) were measured at a mean age 15.5 years in 1,308 female participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Multivariable linear regression was used to examine associations of AMH with these cardiometabolic outcomes.&lt;/p&gt; &lt;p&gt;Results: AMH values ranged from 0.16–35.84 ng/ml and median AMH was 3.57 ng/ml (IQR: 2.41, 5.49). For females classified as post-pubertal (n = 848) at the time of assessment median (IQR) AMH was 3.81 ng/ml (2.55, 5.82) compared with 3.25 ng/ml (2.23, 5.05) in those classed as early pubertal (n = 460, P≤0.001). After adjusting for birth weight, gestational age, pubertal stage, age, ethnicity, socioeconomic position, adiposity and use of hormonal contraceptives, there were no associations with any of the cardiometabolic outcomes. For example fasting insulin changed by 0% per doubling of AMH (95%CI: −3%,+2%) p = 0.70, with identical results if HOMA-IR was used. Results were similar after additional adjustment for smoking, physical activity and age at menarche, after exclusion of 3% of females with the highest AMH values, after excluding those that had not started menarche and after excluding those using hormonal contraceptives.&lt;/p&gt; &lt;p&gt;Conclusion: Our results suggest that in healthy adolescent females, AMH is not associated with cardiometabolic risk factors.&lt;/p&gt

A Semi-Lagrangian scheme for a modified version of the Hughes model for pedestrian flow

In this paper we present a Semi-Lagrangian scheme for a regularized version of the Hughes model for pedestrian flow. Hughes originally proposed a coupled nonlinear PDE system describing the evolution of a large pedestrian group trying to exit a domain as fast as possible. The original model corresponds to a system of a conservation law for the pedestrian density and an Eikonal equation to determine the weighted distance to the exit. We consider this model in presence of small diffusion and discuss the numerical analysis of the proposed Semi-Lagrangian scheme. Furthermore we illustrate the effect of small diffusion on the exit time with various numerical experiments

Probiotic supplementation increases carbohydrate metabolism in trained male cyclists: a randomized, double-blind, placebo-controlled cross-over trial.

We hypothesised that probiotic supplementation (PRO) increases the absorption and oxidation of orally ingested maltodextrin during 2h endurance cycling, thereby sparing muscle glycogen for a subsequent time trial (simulating a road race). Measurements were made of lipid and carbohydrate oxidation, plasma metabolites and insulin, gastrointestinal permeability, and subjective symptoms of discomfort. Seven male cyclists were randomized to PRO (bacterial composition given in methods) or placebo (PLC) for four weeks, separated by a 14-day washout period. After each period, cyclists consumed a 10% maltodextrin solution (initial 8 mL·kg-1 bolus and 2 mL·kg-1 every 15 min) while exercising for 2h at 55% Wmax followed by a 100 kJ time trial. PRO resulted in small increases in peak oxidation rates of the ingested maltodextrin (0.84 ± 0.10 vs 0.77 ± 0.09 g·min-1, P = 0.016), and mean total carbohydrate oxidation (2.20 ± 0.25 vs 1.87 ± 0.39 g·min-1, P = 0.038), while fat oxidation was reduced (0.40 ± 0.11 vs 0.55 ± 0.10 g·min-1, P = 0.021) . During PRO small but significant increases were seen in glucose absorption, plasma glucose and insulin concentration and decreases in NEFA and glycerol. Differences between markers of GI damage and permeability and time trial performance were not significant (P > 0.05). In contrast to the hypothesis, PRO led to minimal increases in absorption and oxidation of the ingested maltodextrin and small reductions in fat oxidation, while having no effect on subsequent time trial performance

Providing competency-based family medicine residency training in substance abuse in the new millennium: a model curriculum

<p>Abstract</p> <p>Background</p> <p>This article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse.</p> <p>Methods</p> <p>The authors reviewed reports of past Family Medicine curriculum development efforts, previously-identified barriers to education in high risk substance use, approaches to overcoming these barriers, and current training guidelines of the Accreditation Council for Graduate Medical Education (ACGME) and their Family Medicine Residency Review Committee. A proposed eight-module curriculum was developed, based on substance abuse competencies defined by Project MAINSTREAM and linked to core competencies defined by the ACGME. The curriculum provides basic training in high risk substance use to all residents, while also addressing current training challenges presented by U.S. work hour regulations, increasing international diversity of Family Medicine resident trainees, and emerging new primary care practice models.</p> <p>Results</p> <p>This paper offers a core curriculum, focused on screening, brief intervention and referral to treatment, which can be adapted by residency programs to meet their individual needs. The curriculum encourages direct observation of residents to ensure that core skills are learned and trains residents with several "new skills" that will expand the basket of substance abuse services they will be equipped to provide as they enter practice.</p> <p>Conclusions</p> <p>Broad-based implementation of a comprehensive Family Medicine residency curriculum should increase the ability of family physicians to provide basic substance abuse services in a primary care context. Such efforts should be coupled with faculty development initiatives which ensure that sufficient trained faculty are available to teach these concepts and with efforts by major Family Medicine organizations to implement and enforce residency requirements for substance abuse training.</p