Food for thought: Dietary nootropics for the optimisation of military operators cognitive performance

Nootropics are compounds that enhance cognitive performance and have been highlighted as a medium-term human augmentation technology that could support soldier performance. Given the differing ethical, safety, and legal considerations associated with the pharmaceutical subset of nootropics, this analysis focuses on dietary supplementation which may enhance cognition during training and operations. Numerous supplements have been investigated as possible nootropics, however research is often not context specific or of high quality, leading to questions regarding efficacy. There are many other complex cofactors that may affect the efficacy of any dietary nootropic supplement which is designed to improve cognition, such as external stressors (e.g., sleep deprivation, high physical workloads), task specifics (e.g., cognitive processes required), and other psychological constructs (e.g., placebo/nocebo effect). Moreover, military population considerations, such as prior nutritional knowledge and current supplement consumption (e.g., caffeine), along with other issues such as supplement contamination should be evaluated when considering dietary nootropic use within military populations. However, given the increasing requirement for cognitive capabilities by military personnel to complete role-related tasks, dietary nootropics could be highly beneficial in specific contexts. Whilst current evidence is broadly weak, nutritional nootropic supplements may be of most use to the military end user, during periods of high military specific stress. Currently, caffeine and L-tyrosine are the leading nootropic supplements candidates within the military context. Future military specific research on nootropics should be of high quality and use externally valid methodologies to maximise the translation of research to practice

Transferability of Military-Specific Cognitive Research to Military Training and Operations

The influence of acute aerobic exercise on cognitive function is well documented (e.g., Lambourne and Tomporowski, 2010; Chang et al., 2012). However, the influence of military specific exercise on aspects of cognitive function relevant to military operations is less well understood. With the increasing physical and cognitive loads placed on military personnel (Mahoney et al., 2007), this interaction is fundamental to understanding operational performance (Russo et al., 2005). As such, ensuring the transferability of military-specific cognitive research to military training and operations, is of great importance, particularly for the development of both mitigation and enhancement strategies (see Brunyé et al., 2020). Despite this, studies have not always considered whether meaningful translations can be made. We suggest that researchers should endeavor to strike the balance between external validity and experimental control (Figure 1), and consider the concept of representative design (Pinder et al., 2011). External validity refers to the transferability of research findings from the research to the target population, whilst representative design refers to methodological approaches chosen to ensure that the experimental task constraints characterize those experienced during performance (i.e., the training or operational environment) (Pinder et al., 2011). Herein, we will focus on representative design during load carriage investigations, due to its mission criticality (Knapik and Reynolds, 2012), and it being the primary physical activity choice during military specific exercise-cognition research. Specifically, we discuss the inclusion of dual-/multi-tasking, implications of study population, cognitive task selection, and the data collection environment

The Development, and Day-to-Day Variation, of a Military-Specific Auditory N-Back Task and Shoot-/Don’t-Shoot Task

During military operations, soldiers are required to successfully complete numerous physical and cognitive tasks concurrently. Understanding the typical variance in research tools that may be used to provide insight into the interrelationship between physical and cognitive performance is therefore highly important. This study assessed the inter-day variability of two military-specific cognitive assessments; a Military-Specific Auditory N-Back Task (MSANT) and a Shoot-/Don’t-Shoot Task (SDST) in 28 participants. Limits of agreement ± 95% Confidence Intervals, Standard Error of the Mean, and Smallest Detectable Change were calculated to quantify the typical variance in task performance. All parameters within the MSANT and SDST demonstrated no mean difference for trial visit in either the seated or walking condition, with equivalency demonstrated for the majority of comparisons. Collectively, these data provided an indication of the typical variance in MSANT and SDST performance, whilst demonstrating that both assessments can be used during seated and walking conditions

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training