Association between chronic intestinal failure etiology and eGFR trajectory in adults receiving home parenteral nutrition: A retrospective longitudinal cohort study.

BACKGROUND: Patients with chronic intestinal failure (CIF) are at increased risk of developing renal impairment. The aim of this study was to evaluate the occurrence of chronic kidney disease (CKD) in patients dependent on home parenteral nutrition (HPN) and assess risk factors for renal impairment, including patients with all mechanisms of CIF. METHODS: This was a cohort study of patients initiated on HPN between March 1, 2015, and March 1, 2020, at a national UK IF Reference Centre. Patients were followed from their first discharge with HPN until HPN cessation or the end of follow-up on December 31, 2021. RESULTS: There were 357 patients included in the analysis. Median follow-up time was 4.7 years. At baseline, >40% of patients had renal impairment, with 15.4% fulfilling the criteria for CKD. Mean estimated glomerular filtration rate (eGFR) decreased significantly during the first year after initiation of HPN from 93.32 ml/min/1.73 m2 to 86.30 ml/min/1.73 m2 at the first year of follow-up (P = 0.002), with sequential stabilization of renal function. Increased age at HPN initiation and renal impairment at baseline were associated with decreased eGFR. By the end of follow-up, 6.7% patients developed renal calculi and 26.1% fulfilled the criteria for CKD. CONCLUSION: This is the largest study of renal function in patients receiving long-term HPN. After the first year following HPN initiation, the rate of decline in eGFR was similar to that expected in the general population. These findings should reassure patients and clinicians that close monitoring of renal function can lead to good outcomes.

A virtual reality paradigm with dynamic scene stimuli for use in memory research.

Episodic memory may essentially be memory for one's place within a temporally unfolding scene from a first-person perspective. Given this, pervasively used static stimuli may only capture one small part of episodic memory. A promising approach for advancing the study of episodic memory is immersing participants within varying scenes from a first-person perspective. We present a pool of distinct scene stimuli for use in virtual environments and a paradigm that is implementable across varying levels of immersion on multiple virtual reality (VR) platforms and adaptable to studying various aspects of scene and episodic memory. In our task, participants are placed within a series of virtual environments from a first-person perspective and guided through a virtual tour of scenes during a study phase and a test phase. In the test phase, some scenes share a spatial layout with studied scenes; others are completely novel. In three experiments with varying degrees of immersion, we measure scene recall, scene familiarity-detection during recall failure, the subjective experience of déjà vu, the ability to predict the next turn on a tour, the subjective sense of being able to predict the next turn on a tour, and the factors that influence memory search and the inclination to generate candidate recollective information. The level of first-person immersion mattered to multiple facets of episodic memory. The paradigm presents a useful means of advancing mechanistic understanding of how memory operates in realistic dynamic scene environments, including in combination with cognitive neuroscience methods such as functional magnetic resonance imaging and electrophysiology.

Piquing Curiosity: Déjà vu-Like States Are Associated with Feelings of Curiosity and Information-Seeking Behaviors.

Curiosity during learning increases information-seeking behaviors and subsequent memory retrieval success, yet the mechanisms that drive curiosity and its accompanying information-seeking behaviors remain elusive. Hints throughout the literature suggest that curiosity may result from a metacognitive signal-possibly of closeness to a not yet accessible piece of information-that in turn leads the experiencer to seek out additional information that will resolve a perceptibly small knowledge gap. We examined whether metacognition sensations thought to signal the likely presence of an as yet unretrieved relevant memory (such as familiarity or déjà vu) might be involved. Across two experiments, when cued recall failed, participants gave higher curiosity ratings during reported déjà vu (Experiment 1) or déjà entendu (Experiment 2), and these states were associated with increased expenditure of limited experimental resources to discover the answer. Participants also spent more time attempting to retrieve information and generated more incorrect information when experiencing these déjà vu-like states than when not. We propose that metacognition signaling of the possible presence of an as yet unretrieved but relevant memory may drive curiosity and prompt information-seeking that includes further search efforts.

On the relationship between tip-of-the-tongue states and partial recollective experience: Illusory partial recollective access during tip-of-the-tongue states.

Most people have experienced the sensation of having a word on the tip of the tongue. A common assumption is that a major driving force underlying the tip-of-the-tongue (TOT) state is conscious partial recollective access to some of the unretrieved word's attributes, such as its first letter. In the present study, under free-report conditions, participants provided more partial recollection responses during TOTs than non-TOTs without being more accurate among their provided responses. Under forced-guessing conditions in which participants needed to guess at the unidentified target word's first letter, participants exhibited false partial recollective experience during TOTs. This was shown by a strong tendency during TOTs to indicate that they knew the first letter, when in actuality, they were wrong in their first-letter guess. An additional experiment showed illusory partial recollection of a contextual detail during TOTs relative to non-TOTs. The full pattern of results portrays an alternative possible theoretical relationship between TOT states and subjective partial recollective experience. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Detecting a familiar person behind the surgical mask: recognition without identification among masked versus sunglasses-covered faces.

Previous research has shown that even when famous people's identities cannot be discerned from faces that have been filtered with monochromatic noise, these unidentifiable famous faces still tend to receive higher familiarity ratings than similarly filtered non-famous faces. Experiment 1 investigated whether a similar face recognition without identification effect would occur among faces whose identification was hindered through the wearing of a surgical mask. Among a mixture of famous and non-famous faces wearing surgical masks and hoods, participants rated how familiar each person seemed then attempted to identify the person. Though surgical masks significantly impaired identification of the famous faces, unidentified masked famous faces received higher familiarity ratings on average than the non-famous masked faces, suggesting that a sense of familiarity could still occur even when identification was impaired by the mask. Experiment 2 compared faces covered by surgical masks with faces covered by sunglasses. Though sunglasses impaired face identification more than surgical masks, the magnitude of the face recognition without identification effect was the same in both cases. This pattern suggests that holistic face processing is not a requirement for the sense of familiarity with a face, and that different facial feature types can contribute.

Can cue familiarity during recall failure prompt illusory recollective experience?

Recognition memory is thought to involve two bases: familiarity (a sense that something was encountered previously) and recollection (retrieval of specifics or context). The present study investigated the hypothesis that a sensation of familiarity during cued-recall failure might increase illusory recollective experience. This hypothesis was driven, in part, by the suggestion in the literature that the type of familiarity-driven recollective confabulation often seen in populations experiencing memory impairment might actually be a common feature of normal human memory. We examined the hypothesis that as perceived cue familiarity increases during the uncertainty of target retrieval failure, so does illusory recollection of a contextual detail. Toward this end, we systematically varied the amount of cue-to-target(s) surface feature-overlap in the recognition without cued recall paradigm, which has been shown to increase perceived cue familiarity during target recall failure. Increasing perceived cue familiarity during target retrieval failure led to increased confidence in knowing a contextual detail that was not actually known. As perceived cue familiarity increased, so did erroneous confidence in knowing the arrow direction (left or right) that supposedly accompanied the unretrieved target (Experiment 1), the background color (Experiment 2), and whether an accompanying tone was high or low (Experiment 3).

Specifying a relationship between semantic and episodic memory in the computation of a feature-based familiarity signal using MINERVA 2.

Approaches to modeling episodic recognition memory often imply a separability from semantic memory insofar as an implicit tabula rasa (i.e., blank slate) assumption is apparent in many simulations. This is evident in the common practice of having new test probes correspond to zero memory traces in the store while old test probes correspond to traces representing instances of items' occurrence on a study list. However, in list-learning studies involving word lists, none of the test items would actually correspond to zero items in the person's memory, as all of the test words are generally known to participants, whether old or new. By focusing on a list-learning recognition phenomenon that likely results from feature-based familiarity detection and necessarily involves a role of preexisting knowledge in its mechanisms-the semantic-feature-based recognition without cued recall phenomenon-we show how incorporating preexisting knowledge into the MINERVA 2 model enables it to simulate previously shown empirical patterns with this phenomenon. The simulation patterns reported here raise new theoretical implications worth further exploration, such as the extent to which the variances change in the signal versus the noise distribution when preexisting knowledge is present versus absent in the simulations.

A community-engaged approach to understanding environmental health concerns and solutions in urban and rural communities.

BACKGROUND: Focus groups and workshops can be used to gain insights into the persistence of and potential solutions for environmental health priorities in underserved areas. The objective of this study was to characterize focus group and workshop outcomes of a community-academic partnership focused on addressing environmental health priorities in an urban and a rural location in Alabama between 2012 and 2019. METHODS: Six focus groups were conducted in 2016 with 60 participants from the City of Birmingham (urban) and 51 participants from Wilcox County (rural), Alabama to discuss solutions for identified environmental health priorities based on previous focus group results in 2012. Recorded focus groups were transcribed and analyzed using the grounded theory approach. Four follow-up workshops that included written survey instruments were conducted to further explore identified priorities and determine whether the priorities change over time in the same urban (68 participants) and rural (72 participants) locations in 2018 and 2019. RESULTS: Consistent with focus groups in 2012, all six focus groups in 2016 in Birmingham identified abandoned houses as the primary environmental priority. Four groups listed attending city council meetings, contacting government agencies and reporting issues as individual-level solutions. Identified city-level solutions included city-led confiscation, tearing down and transferring of abandoned property ownership. In Wilcox County, all six groups agreed the top priority was drinking water quality, consistent with results in 2012. While the priority was different in Birmingham versus Wilcox County, the top identified reason for problem persistence was similar, namely unresponsive authorities. Additionally, individual-level solutions identified by Wilcox County focus groups were similar to Birmingham, including contacting and pressuring agencies and developing petitions and protesting to raise awareness, while local policy-level solutions identified in Wilcox County included government-led provision of grants to improve septic systems, and transparency in allocation of funds. Workshops in 2018 and 2019 further emphasized water quality as the top priority in Wilcox County, while participants in Birmingham transitioned from abandoned houses as a top priority in 2018 to drinking water quality as a new priority in 2019. CONCLUSIONS: Applying a community-engaged approach in both urban and rural locations provided better understanding of the unique opportunities and challenges for identifying potential interventions for environmental health priorities in both locations. Results can help inform future efforts to address locally defined environmental health issues and solutions.

The tip-of-the-tongue state as a form of access to information: Use of tip-of-the-tongue states for strategic adaptive test-taking.

Though tip-of-the-tongue (TOT) states are traditionally viewed as instances of retrieval failure, some suggest that they are a unique form of retrieval success. The state indicates the presence of something relevant in memory as opposed to nothing. TOTs potentially present an opportunity to indicate that more knowledge is present than is currently accessible, which might have relevance for how tests are designed. The present study investigated this. During TOT states, participants were more likely to risk requesting a later multiple-choice set of potential answers when a point loss penalty for wrong answers would occur; they were also more likely to actually choose the correct multiple-choice answer. A test designed for differential point gain or loss through strategic use of TOT states during word generation failure resulted in a point gain advantage compared to standard multiple-choice type testing. This pattern presents a proof of concept relevant to designing adaptive tests.

Déjà vu and the feeling of prediction: an association with familiarity strength.

A recent laboratory study by Cleary and Claxton [2018. Déjà vu: An illusion of prediction. Psychological Science, 29(4), 635-644. http://journals.sagepub.com/doi/full/10.1177/0956797617743018] documented a relationship between déjà vu and feelings of premonition. During instances of retrieval failure, participants reported stronger feelings of prediction during déjà vu than non-déjà vu states, despite displaying no actual predictive ability in such instances. The present study further explored the link between déjà vu reports and feelings of prediction. Although feelings of prediction were more likely to occur during reports of déjà vu than non-déjà vu, they were not the sole defining feature of déjà vu, accounting for just over half of all reported déjà vu states. Instances of déjà vu that were accompanied by feelings of prediction were associated with greater feelings of familiarity than instances that were not. This was shown by a greater likelihood of reporting that the scene felt familiar and also by a higher rated intensity of the feeling of familiarity elicited by the scene when it did feel familiar. Though the present study was mainly descriptive in characterising the interrelations between déjà vu, feelings of prediction, and familiarity, the full pattern points toward the possibility that high familiarity intensity may contribute to the feeling of prediction during déjà vu.

Randomised clinical trial of a gastrointestinal care bundle to reduce symptoms in patients with pelvic cancer undergoing chemoradiotherapy.

OBJECTIVE: Pelvic radiotherapy is used to treat 17 000 people in the UK each year. Eight in 10 develop difficult bowel problems during pelvic treatment, especially diarrhoea, urgency and incontinence. Some cannot complete treatment, reducing the chance of cancer cure. Undertaking gastroenterologist-led investigation and management during pelvic radiotherapy has never been evaluated. In this study, we aimed to assess whether patients could successfully receive a novel gastrointestinal (GI) care bundle during chemoradiotherapy (feasibility aim) and would experience reduced symptom severity (clinical impact aim). DESIGN: This randomised controlled trial recruited patients with cervical and bladder cancers undergoing radical chemoradiotherapy. Participants were randomised to intervention or control groups. Questionnaire and anthropometric data were collected. All intervention group patients received individualised dietary counselling weekly throughout treatment, and if bowel symptoms developed they were offered rapid-access investigation and treatment for any identified pathology: lactose intolerance, bacterial overgrowth or bile acid malabsorption. RESULTS: Feasibility: 50 participants were recruited, 24 were randomised to the intervention group and 26 to the control group. All completed 20 fractions of external beam pelvic radiotherapy. It was possible to perform 57/72 (79%) of proposed intervention tests with no disruption of oncological management. CLINICAL IMPACT: All participants developed GI symptoms during radiotherapy. The median symptom score for each group increased from baseline at 6 weeks. This was from 0.156 (0.000-0.333) to 0.600 (0.250-1.286) in the control group, and from 0.00 (0.000-0.300) to 0.402 (0.000-0.667) in the intervention group. CONCLUSION: It was feasible to recruit to and deliver a randomised controlled trial of interventions in patients undergoing pelvic chemoradiotherapy. Lower median bowel scores were reported in the intervention group at 6 weeks, with fewer patients experiencing symptoms overall. TRIAL REGISTRATION NUMBER: ISRCTN783488.

The tip-of-the-tongue state bias permeates unrelated concurrent decisions and behavior.

The tip-of-the-tongue (TOT) state-the feeling of being near accessing an as yet inaccessible word from memory-is associated with cognitive bias. For example, prior work has shown that TOTs are associated with a bias toward inferring positive qualities of the unretrieved information. People are biased during TOTs to indicate that the unretrieved target has a greater likelihood of being positively valenced and to have been associated with a higher value number earlier in the experiment. Additionally, when the TOT is for a pictured person's name, that person is judged to be more likely to be ethical. The present study demonstrates that the TOT positivity bias extends to unrelated concurrent decisions and behavior. In Experiment 1, participants reported a greater inclination to take an unrelated gamble during TOTs than non-TOTs. Experiment 2 demonstrated the concurrent nature of this spillover effect. The TOT bias toward a greater inclination to gamble significantly diminished with a 10-second delay between the time of reporting the TOT state and the time to report the inclination. Finally, Experiment 3 showed that the increased inclination to want to take a gamble during TOTs translated to actual gambling behavior. Participants chose to gamble for points more often during TOTs than non-TOTs.

A postdictive bias associated with déjà vu.

Recent research links reports of déjà vu - the feeling of having experienced something before despite knowing otherwise - with an illusory feeling of prediction. In the present study, a new finding is presented in which reports of déjà vu are associated not only with a predictive bias, but also with a postdictive bias, whereby people are more likely to feel that an event unfolded as expected after the event prompted déjà vu than after it did not. During a virtual tour, feelings of predicting the next turn were more likely during reported déjà vu, as in prior research. Then, after actually seeing the turn, participants exhibited a postdictive bias toward feeling that the scene unfolded as expected following déjà vu reports. This postdictive bias following déjà vu reports was associated with higher perceived scene familiarity intensity. A potential reason for this association may be that high familiarity intensity as an event outcome unfolds falsely signals confirmatory evidence of having sensed all along how it would unfold. Future research should further investigate this possibility.

Pityriasis rubra pilaris.

Pityriasis rubra pilaris is a chronic, papulosquamous dermatosis of unclear etiology. The case of a 61-year-old man with pityriasis rubra pilaris is presented. The clinical forms, histopathologic features, and treatment options of pityriasis rubra pilaris are reviewed.