Cognitive Binding: A Computational-Modeling Analysis of a Distinction between Implicit and Explicit Memory

Four models were compared on repeated explicit memory (fragment cued recall) or implicit memory (fragment completion) tasks (Hayman and Tulving, 1989a). In the experiments, when given explicit instructions to complete fragments with words from a just-studied list—the explicit condition—people showed a dependence relation between the first and the second fragment targeted at the same word. However, when subjects were just told to complete the (primed) fragments—the implicit condition—stochastic independence between the two fragments resulted. Three distributed models—CHARM, a competitive-learning model, and a back-propagation model produced dependence, as in the explicit memory test. In contrast, a separate-trace model, MINERVA, showed independence, as in the implicit task. It was concluded that explicit memory is based on a highly interactive network that glues or binds together the features within the items, as do the first three models. The binding accounts for the dependence relation. Implicit memory appears to be based, instead, on separate non interacting traces

Neural Correlates of People's Hypercorrection of Their False Beliefs

Despite the intuition that strongly held beliefs are particularly difficult to change, the data on error correction indicate that general information errors that people commit with a high degree of belief are especially easy to correct. This finding is called the hypercorrection effect. The hypothesis was tested that the reason for hypercorrection stems from enhanced attention and encoding that results from a metacognitive mismatch between the person's confidence in their responses and the true answer. This experiment, which is the first to use imaging to investigate the hypercorrection effect, provided support for this hypothesis, showing that both metacognitive mismatch conditions—that in which high confidence accompanies a wrong answer and that in which low confidence accompanies a correct answer—revealed anterior cingulate and medial frontal gyrus activations. Only in the high confidence error condition, however, was an error that conflicted with the true answer mentally present. And only the high confidence error condition yielded activations in the right TPJ and the right dorsolateral pFC. These activations suggested that, during the correction process after error commission, people (1) were entertaining both the false belief as well as the true belief (as in theory of mind tasks, which also manifest the right TPJ activation) and (2) may have been suppressing the unwanted, incorrect information that they had, themselves, produced (as in think/no-think tasks, which also manifest dorsolateral pFC activation). These error-specific processes as well as enhanced attention because of metacognitive mismatch appear to be implicated

Dissociating Neural Correlates of Action Monitoring and Metacognition of Agency

Judgments of agency refer to people's self-reflective assessments concerning their own control: their assessments of the extent to which they themselves are responsible for an action. These self-reflective metacognitive judgments can be distinguished from action monitoring, which involves the detection of the divergence (or lack of divergence) between observed states and expected states. Presumably, people form judgments of agency by metacognitively reflecting on the output of their action monitoring and then consciously inferring the extent to which they caused the action in question. Although a number of previous imaging studies have been directed at action monitoring, none have assessed judgments of agency as a potentially separate process. The present fMRI study used an agency paradigm that not only allowed us to examine the brain activity associated with action monitoring but that also enabled us to investigate those regions associated with metacognition of agency. Regarding action monitoring, we found that being “out of control” during the task (i.e., detection of a discrepancy between observed and expected states) was associated with increased brain activity in the right TPJ, whereas being “in control” was associated with increased activity in the pre-SMA, rostral cingulate zone, and dorsal striatum (regions linked to self-initiated action). In contrast, when participants made self-reflective metacognitive judgments about the extent of their own control (i.e., judgments of agency) compared with when they made judgments that were not about control (i.e., judgments of performance), increased activity was observed in the anterior PFC, a region associated with self-reflective processing. These results indicate that action monitoring is dissociable from people's conscious self-attributions of control

Dissociable Neural Substrates for Agentic versus Conceptual Representations of Self

Although humans generally experience a coherent sense of selfhood, we can nevertheless articulate different aspects of self. Recent research has demonstrated that one such aspect of self—conceptual knowledge of one's own personality traits—is subserved by ventromedial prefrontal cortex (vMPFC). Here, we examined whether an alternative aspect of “self”—being an agent who acts to achieve one's own goals—relies on cognitive processes that overlap with or diverge from conceptual operationalizations of selfhood. While undergoing fMRI, participants completed tasks of both conceptual self-reference, in which they judged their own or another person's personality traits, and agentic self-reference, in which they freely chose an object or watched passively as one was chosen. The agentic task failed to modulate vMPFC, despite producing the same memory enhancement frequently observed during conceptual self-referential processing (the “self-reference” effect). Instead, agentic self-reference was associated with activation of the intraparietal sulcus (IPS), a region previously implicated in planning and executing actions. Experiment 2 further demonstrated that IPS activity correlated with later memory performance for the agentic, but not conceptual, task. These results support views of the “self” as a collection of distinct mental operations distributed throughout the brain, rather than a unitary cognitive system

Making Memorial Student-Ready: Reflections on the First Year Success Experience

In eleven short chapters faculty, academic advising staff and student union representatives discuss aspects of Memorial’s First Year Success Program (piloted as a Teaching Learning Framework initiative 2012-2017). Teaching approaches, curriculum content and policy rationales are covered in a broad view of how and why students identified as least likely to succeed at university can be academically supported. Contributors identify the singular importance of the community that First Year Success provided them and its student participants

Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.

AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791

The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm

Aims To investigate whether aneurysm shape and extent, which indicate whether a patient with ruptured abdominal aortic aneurysm (rAAA) is eligible for endovascular repair (EVAR), influence the outcome of both EVAR and open surgical repair. Methods and results The influence of six morphological parameters (maximum aortic diameter, aneurysm neck diameter, length and conicality, proximal neck angle, and maximum common iliac diameter) on mortality and reinterventions within 30 days was investigated in rAAA patients randomized before morphological assessment in the Immediate Management of the Patient with Rupture: Open Versus Endovascular strategies (IMPROVE) trial. Patients with a proven diagnosis of rAAA, who underwent repair and had their admission computerized tomography scan submitted to the core laboratory, were included. Among 458 patients (364 men, mean age 76 years), who had either EVAR (n = 177) or open repair (n = 281) started, there were 155 deaths and 88 re-interventions within 30 days of randomization analysed according to a pre-specified plan. The mean maximum aortic diameter was 8.6 cm. There were no substantial correlations between the six morphological variables. Aneurysm neck length was shorter in those undergoing open repair (vs. EVAR). Aneurysm neck length (mean 23.3, SD 16.1 mm) was inversely associated with mortality for open repair and overall: adjusted OR 0.72 (95% CI 0.57, 0.92) for each 16 mm (SD) increase in length. There were no convincing associations of morphological parameters with reinterventions. Conclusion Short aneurysm necks adversely influence mortality after open repair of rAAA and preclude conventional EVAR. This may help explain why observational studies, but not randomized trials, have shown an early survival benefit for EVAR. Clinical trial registration: ISRCTN 48334791

The QuinteT Recruitment Intervention supported five randomized trials to recruit to target: a mixed-methods evaluation

ObjectiveTo evaluate the impact of the Quintet Recruitment Intervention (QRI) on recruitment in challenging randomized controlled trials (RCTs) that have applied the intervention. The QRI aims to understand recruitment difficulties, and then implements ‘QRI-actions’ to address these as recruitment proceeds.Study Design and SettingA mixed-methods study, comprising: a) before-and-after comparisons of recruitment rates and numbers of patients approached, and b) qualitative case studies, including documentary analysis and interviews with RCT investigators.ResultsFive UK-based publicly-funded RCTs were included in the evaluation. All recruited to target. RCT2 and RCT5 both received up-front pre-recruitment training before the intervention was applied. RCT2 did not encounter recruitment issues and recruited above target from its outset. Recruitment difficulties, particularly communication issues, were identified and addressed through QRI-actions in RCTs 1, 3, 4 and 5. Randomization rates significantly improved post-QRI-action in RCTs 1,3, and 4. QRI-actions addressed issues with approaching eligible patients in RCTs 3 and 5, which both saw significant increases in patients approached. Trial investigators reported that the QRI had unearthed issues they had been unaware of, and reportedly changed their practices post QRI-action.ConclusionThere is promising evidence to suggest the QRI can support recruitment to difficult RCTs. This needs to be substantiated with future controlled evaluations

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome