Intact strategic retrieval processes in older adults: No evidence for age-related deficits in source-constrained retrieval

Aging is thought to involve impairments to cognitive control functions that support episodic memory, for example by enabling people to strategically constrain their retrieval search towards a specific context (“source”) in order to facilitate retrieval of goal-relevant memories. The “memory-for-foils” paradigm investigates source-constrained retrieval by assessing whether incidental encoding of new foils during an old/new recognition test differs depending on the type of processing that was previously used during study of the old items in the test. If it does, it suggests that people process foils differently as a result of engaging in source-constrained retrieval attempts. Young adults typically show differences in incidental encoding foils, but such differences have not been found in older adults. Here, we compared source-constrained retrieval and reward effects on incidental foil encoding between younger and older adults, to assess if age-related reductions in strategic retrieval processing are accompanied by differences in responsiveness to external rewards. The results showed only minor effects of rewards on memory processing, in younger adults only. Contrary to prior findings, older adults had equivalent overall memory performance and spontaneously constrained retrieval to the same extent as the young group, showing that aging-related impairments to strategic retrieval processes are not inevitable

Alienated and unsafe: Experiences of the first national UK COVID-19 lockdown for vulnerable young people (aged 11–24 years) as revealed in Web-based therapeutic sessions with mental health professionals

Background: The COVID-19 pandemic and subsequent lockdowns have disproportionately affected young people, and those who are vulnerable are disadvantaged further. Here, we seek to understand the experiences of vulnerable young people accessing Web- based therapeutic support during the pandemic and early lockdown, as revealed through the observations of mental health professionals. Methods: Four focus groups with 12 professionals from a digital mental health service were conducted to understand the experiences of vulnerable young people during the pandemic lockdown. Workshops with young people with diverse experiences resulted in the co-design of the focus group topic guide and the interpretation and validation of analysis. The experiential inductive–deductive framework of thematic analysis was used to analyse the workshop transcripts. Results: Four main themes and subsequent subthemes were identified: escalation of risk; the experience and consequence of loss; feeling supported and empowered; and feel-ing separate and isolated. Conclusions: Findings reflect early data that suggest that those with existing vulnerability face an increased risk of poor outcomes through the pandemic and the restrictions of lockdown, but evidence is also provided of positive outcomes from lockdown and its function as a catalyst for change. Results reinforce the need for focused sup-port for vulnerable young people as we emerge from lockdown, and point to supportive and protective factors of relevance to online and offline support provision

Investigating subtypes of reward processing deficits as trait markers for depression

Background: Anhedonia, the loss of pleasure in usually enjoyable activities, is a central feature of major depressive disorder (MDD). The aim of the present study was to examine whether young people at a familial risk of depression display signs of anticipatory, motivational or consummatory anhedonia, which would indicate that these deficits may be trait markers for MDD. Methods: The study was completed by 22 participants with a family history of depression (FH+) and 21 controls (HC). Anticipatory anhedonia was assessed by asking participants to rate their anticipated liking of pleasant and unpleasant foods which they imagined tasting when cued with images of the foods. Motivational anhedonia was measured by requiring participants to perform key presses to obtain pleasant chocolate taste rewards or to avoid unpleasant apple tastes. Additionally, physical consummatory anhedonia was examined by instructing participants to rate the pleasantness of the acquired tastes. Moreover, social consummatory anhedonia was investigated by asking participants to make preference-based choices between neutral facial expressions, genuine smiles, and polite smiles. Results: It was found that the FH+ group’s anticipated liking of unpleasant foods was significantly lower than that of the control group. By contrast, no group differences in the pleasantness ratings of the actually experienced tastes or in the amount of performed key presses were observed. However, controls preferred genuine smiles over neutral expressions more often than they preferred polite smiles over neutral expressions, while this pattern was not seen in the FH+ group. Conclusion: These findings suggest that FH+ individuals demonstrate an altered anticipatory response to negative stimuli and show signs of social consummatory anhedonia, which may be trait markers for depression

Examining concurrent validity and item selection of the Session Wants and Needs Outcome Measure (SWAN-OM) in a children and young people web-based therapy service

Background: Single-session mental health interventions are frequently attended by children and young people (CYP) in both web-based and face-to-face therapy settings. The Session “Wants” and “Needs” Outcome Measure (SWAN-OM) is an instrument developed in a web-based therapy service to overcome the challenges of collecting outcomes and experiences of single-session therapies (SSTs). It provides pre-defined goals for the session, selected by the young person prior to the intervention, on which progress toward achievement is scored at the end of the session. Objective: The objective of this study was to evaluate the instrument's psychometric properties, including concurrent validity against three other frequently used outcome and experience measures, at a web-based and text-based mental health service. Methods: The SWAN-OM was administered for a period of 6 months to 1,401 CYP (aged 10–32 years; 79.3% white; 77.59% female) accessing SST on a web-based service. Item correlations with comparator measures and hierarchical logistic regressions to predict item selection were calculated for concurrent validity and psychometric exploration. Results: The most frequently selected items were “Feel better” (N = 431; 11.61%) and “Find ways I can help myself” (N = 411; 11.07%); unpopular items were “Feel safe in my relationships” (N = 53; 1.43%) and “Learn the steps to achieve something I want” (N = 58; 1.56%). The SWAN-OM was significantly correlated with the Experience of Service Questionnaire, particularly the item “Feel better” [rs(109) = 0.48, p < 0.001], the Youth Counseling Impact Scale, particularly the item “Learn the steps to achieve something I want” [rs(22) = 0.76, p < 0.001], and the Positive and Negative Affect Schedule, particularly the items “Learn how to feel better” [rs(22) = 0.72, p < 0.001] and “Explore how I feel” [rs(70) = −0.44, p < 0.001]. Conclusion: The SWAN-OM demonstrates good concurrent validity with common measures of outcome and experience. Analysis suggests that lesser-endorsed items may be removed in future iterations of the measure to improve functionality. Future research is required to explore SWAN-OM's potential to measure meaningful change in a range of therapeutic settings

The design and development of an experience measure for a peer community moderated forum in a digital mental health service.

Online digital mental health communities can contribute to users' mental health positively and negatively. Yet the measurement of experience, outcomes and impact mechanisms relating to digital mental health communities is difficult to capture. In this paper we demonstrate the development of an online experience measure for a specific children and young people's community forum inside a digital mental health service. The development of the Peer Online Community Experience Measure (POCEM) is informed by a multi-phased design: (i) item reduction through Estimate-Talk-Estimate modified Delphi methods, (ii) user testing with think-aloud protocols and (iii) a pilot study within the digital service community to explore observational data within the platform. Experts in the field were consulted to help reduce the items in the pool and to check their theoretical coherence. User testing workshops helped to inform the usability appearance, wording, and purpose of the measure. Finally, the pilot results highlight completion rates, differences in scores for age and roles and "relate to others", as the most frequent domain mechanism of support for this community. Outcomes frequently selected show the importance of certain aspects of the community, such as safety, connection, and non-judgment previously highlighted in the literature. Experience measures like this one could be used as indicators of active therapeutic engagement within the forum community and its content but further research is required to ascertain its acceptability and validity. Multi-phased approaches involving stakeholders and user-centred design activities enhances the development of digitally enabled measurement tools

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Factors that affect incidental encoding during retrieval attempts: Effects of reward, retrieval processes and healthy ageing.

A successful strategy to aid recognition is to constrain retrieval search towards a specific context in order to facilitate retrieval of goal-relevant memories. The "memory-for-foils" paradigm is used to investigate this process, termed source-constrained retrieval, by assessing whether incidental encoding of new foils during an old/new recognition test differs depending on the type of processing that was previously used during study of the old items in the test. Ageing is thought to involve impairments to cognitive control functions that support episodic memory as well as a reliance on familiarity-based recognition, suggesting that older adults will be less able to constrain retrieval search than younger adults. This thesis extends on prior source-constrained retrieval literature and explored what potential other factors could modulate the rate of incidental foil encoding. Novel factors of external reward, as well as an internal factor of item-specific retrieval processes and subjective judgments were examined, as well as how these factors are affected by healthy ageing. Contrasting to prior findings, here I show that older adults can spontaneously constrain retrieval to the same extent as younger adults, suggesting that ageing-related episodic memory decline, even in cognitively complex tasks, is not inevitable. However, there was little support for external rewards enhancing incidental encoding beyond altering response biases, despite effects of reward on motivation. Item-elicited retrieval processes however were more strongly related to foil memory, with false familiarity and heightened novelty processing for foils during an initial encounter being the most consistent predictors of increased subsequent recognition after incidental encoding. The neural ERP findings also demonstrated that spontaneous recognition processes elicited by new items have a knock-on effect on their incidental encoding, as well as succinctly showing that episodic memory tasks designated as encoding and retrieval phases are not 'process pure'