Machine learning can predict disease manifestations and outcomes in lymphangioleiomyomatosis.

BACKGROUND: Lymphangioleiomyomatosis (LAM) is a rare multisystem disease with variable clinical manifestations and differing rates of progression that make management decisions and giving prognostic advice difficult. We used machine learning to identify clusters of associated features which could be used to stratify patients and predict outcomes in individuals. PATIENTS AND METHODS: Using unsupervised machine learning we generated patient clusters using data from 173 women with LAM from the UK and 186 replication subjects from the US National Heart, Lung, and Blood Institute (NHLBI) LAM registry. Prospective outcomes were associated with cluster results. RESULTS: Two- and three-cluster models were developed. A three-cluster model separated a large group of subjects presenting with dyspnoea or pneumothorax from a second cluster with a high prevalence of angiomyolipoma symptoms (p=0.0001) and tuberous sclerosis complex (TSC) (p=0.041). Patients in the third cluster were older, never presented with dyspnoea or pneumothorax (p=0.0001) and had better lung function. Similar clusters were reproduced in the NHLBI cohort. Assigning patients to clusters predicted prospective outcomes: in a two-cluster model the future risk of pneumothorax was 3.3 (95% CI 1.7-5.6)-fold greater in cluster 1 than cluster 2 (p=0.0002). Using the three-cluster model, the need for intervention for angiomyolipoma was lower in clusters 2 and 3 than cluster 1 (p<0.00001). In the NHLBI cohort, the incidence of death or lung transplant was much lower in clusters 2 and 3 (p=0.0045). CONCLUSIONS: Machine learning has identified clinically relevant clusters associated with complications and outcome. Assigning individuals to clusters could improve decision making and prognostic information for patients.

Measurement of Sexual Interests with Pupillary Responses: A Meta-Analysis.

Objective measures of sexual interest are important for research on human sexuality. There has been a resurgence in research examining pupil dilation as a potential index of sexual orientation. We carried out a meta-analytic review of studies published between 1965 and 2020 (Mdn year = 2016) measuring pupil responses to visual stimuli of adult men and women to assess sexual interest. Separate meta-analyses were performed for six sexual orientation categories. In the final analysis, 15 studies were included for heterosexual men (N = 550), 5 studies for gay men (N = 65), 4 studies for bisexual men (N = 124), 13 studies for heterosexual women (N = 403), and 3 studies for lesbian women (N = 132). Only heterosexual and gay men demonstrated discrimination in pupillary responses that was clearly in line with their sexual orientation, with greater pupil dilation to female and male stimuli, respectively. Bisexual men showed greater pupil dilation to male stimuli. Although heterosexual women exhibited larger pupils to male stimuli compared to female stimuli, the magnitude of the effect was small and non-significant. Finally, lesbian women displayed greater pupil dilation to male stimuli. Three methodological moderators were identified-the sexual explicitness of stimulus materials, the measurement technique of pupillary response, and inclusion of self-report measures of sexual interest. These meta-analyses are based on a limited number of studies and are therefore preliminary. However, the results suggest that pupillary measurement of sexual interest is promising for men and that standardization is essential to gain a better understanding of the validity of this measurement technique for sexual interest.

Comparing methods for the analysis of pupillary response.

Changes in eye-pupil size index a range of cognitive processes. However, variations in the protocols used to analyze such data exist in the psychological literature. This raises the question of whether different approaches to pupillary response data influence the outcome of the analysis. To address this question, four methods of analysis were compared, using pupillary responses to sexually appetitive visual content as example data. These methods comprised analysis of the unadjusted (raw) pupillary response data, z-scored data, percentage-change data, and data transformed by a prestimulus baseline correction. Across two experiments, these methods yielded near-identical outcomes, leading to similar conclusions. This suggests that the range of approaches that are employed in the psychological literature to analyze pupillary response data do not fundamentally influence the outcome of the analysis. However, some systematic carryover effects were observed when a prestimulus baseline correction was applied, whereby dilation effects from an arousing target on one trial still influenced pupil size on the next trial. This indicates that the appropriate application of this analysis might require additional information, such as prior knowledge of the duration of carryover effects.

The vitamin D binding protein axis modifies disease severity in lymphangioleiomyomatosis.

Lymphangioleiomyomatosis (LAM) is a rare disease of women. Decline in lung function is variable, making appropriate targeting of therapy difficult. We used unbiased serum proteomics to identify markers associated with outcome in LAM.101 women with LAM and 22 healthy controls were recruited from the National Centre for LAM in the UK. 152 DNA and serum samples with linked lung function and outcome data were obtained from patients in the National Heart, Lung and Blood Institute LAM Registry in the USA. Proteomic analysis was performed on a discovery cohort of 50 LAM and 20 control serum samples using a SCIEX SWATH mass spectrometric workflow. Protein levels were quantitated by ELISA and single nucleotide polymorphisms in GC (group-specific component) encoding vitamin D binding protein (VTDB) were genotyped.Proteomic analysis showed VTDB was 2.6-fold lower in LAM than controls. Serum VTDB was lower in progressive compared with stable LAM (p=0.001) and correlated with diffusing capacity of the lung for carbon monoxide (p=0.01). Median time to death or lung transplant was reduced by 46 months in those with CC genotypes at rs4588 and 38 months in those with non-A-containing haplotypes at rs7041/4588 (p=0.014 and 0.008, respectively).The VTDB axis is associated with disease severity and outcome, and GC genotype could help predict transplant-free survival in LAM.

Latency-Based and Psychophysiological Measures of Sexual Interest Show Convergent and Concurrent Validity.

Latency-based measures of sexual interest require additional evidence of validity, as do newer pupil dilation approaches. A total of 102 community men completed six latency-based measures of sexual interest. Pupillary responses were recorded during three of these tasks and in an additional task where no participant response was required. For adult stimuli, there was a high degree of intercorrelation between measures, suggesting that tasks may be measuring the same underlying construct (convergent validity). In addition to being correlated with one another, measures also predicted participants' self-reported sexual interest, demonstrating concurrent validity (i.e., the ability of a task to predict a more validated, simultaneously recorded, measure). Latency-based and pupillometric approaches also showed preliminary evidence of concurrent validity in predicting both self-reported interest in child molestation and viewing pornographic material containing children. Taken together, the study findings build on the evidence base for the validity of latency-based and pupillometric measures of sexual interest.

Pupillary Response as an Age-Specific Measure of Sexual Interest.

In the visual processing of sexual content, pupil dilation is an indicator of arousal that has been linked to observers' sexual orientation. This study investigated whether this measure can be extended to determine age-specific sexual interest. In two experiments, the pupillary responses of heterosexual adults to images of males and females of different ages were related to self-reported sexual interest, sexual appeal to the stimuli, and a child molestation proclivity scale. In both experiments, the pupils of male observers dilated to photographs of women but not men, children, or neutral stimuli. These pupillary responses corresponded with observer's self-reported sexual interests and their sexual appeal ratings of the stimuli. Female observers showed pupil dilation to photographs of men and women but not children. In women, pupillary responses also correlated poorly with sexual appeal ratings of the stimuli. These experiments provide initial evidence that eye-tracking could be used as a measure of sex-specific interest in male observers, and as an age-specific index in male and female observers.

Visualizing complex processes using a cognitive-mapping tool to support the learning of clinical reasoning.

BACKGROUND: Practical experience with clinical cases has played an important role in supporting the learning of clinical reasoning. However, learning through practical experience involves complex processes difficult to be captured by students. This study aimed to examine the effects of a computer-based cognitive-mapping approach that helps students to externalize the reasoning process and the knowledge underlying the reasoning process when they work with clinical cases. A comparison between the cognitive-mapping approach and the verbal-text approach was made by analyzing their effects on learning outcomes. METHODS: Fifty-two third-year or higher students from two medical schools participated in the study. Students in the experimental group used the computer-base cognitive-mapping approach, while the control group used the verbal-text approach, to make sense of their thinking and actions when they worked with four simulated cases over 4 weeks. For each case, students in both groups reported their reasoning process (involving data capture, hypotheses formulation, and reasoning with justifications) and the underlying knowledge (involving identified concepts and the relationships between the concepts) using the given approach. RESULTS: The learning products (cognitive maps or verbal text) revealed that students in the cognitive-mapping group outperformed those in the verbal-text group in the reasoning process, but not in making sense of the knowledge underlying the reasoning process. No significant differences were found in a knowledge posttest between the two groups. CONCLUSIONS: The computer-based cognitive-mapping approach has shown a promising advantage over the verbal-text approach in improving students' reasoning performance. Further studies are needed to examine the effects of the cognitive-mapping approach in improving the construction of subject-matter knowledge on the basis of practical experience.

Two Attentional Processes Subserving Working Memory Differentiate Gifted and Mainstream Students.

Two working memory (WM) measures were contrasted, to clarify the nature of advantages in gifted children's cognitive processing. It was predicted that cognitively gifted children would excel in WM tasks taxing mental attention (i.e., n-back) but not tasks supported by perceptual attention (i.e., self-ordered pointing, SOPT). Ninety-one children aged 9-10 and 13-14 years, in a gifted or mainstream classroom, received n-back and SOPT, plus measures of mental-attentional (M-) capacity, inhibition, and shifting. Older children generally scored higher than younger children. As predicted, gifted children outperformed mainstream peers on all tasks, except for SOPT. Results demonstrate the need to distinguish between mental and perceptual attention in measurement of WM.

Your ID, please? The effect of facemasks and makeup on perceptions of age of young adult female faces.

During the COVID-19 pandemic, wearing facemasks was mandatory in the United Kingdom except for individuals with medical exemptions. Facemasks cover the full lower half of the face; however, the effect of facemasks on age perception is not yet known. The present study examined whether age estimation accuracy of unfamiliar young adult women is impaired when the target is wearing a facemask. This study also examined whether makeup, which has previously been shown to increase error bias, further impairs age estimation accuracy when paired with a facemask. The findings indicate that both facemasks and makeup tend to result in overestimation of the young women's age compared to neutral faces, but the combination of both is not additive. Individual level analysis also revealed large individual differences in age estimation accuracy ranging from estimates within 1 year of the target's actual age, and age estimates which deviated by up to 20 years.

Targeting the Dietary Na:K Ratio-Considerations for Design of an Intervention Study to Impact Blood Pressure.

Despite medical, dietary, and lifestyle recommendations and drug advancements, hypertension persists as among the most prevalent noncommunicable diseases in the US population, and control remains elusive. Uncontrolled hypertension may increase the risk of serious illness from various other health challenges, including cardiovascular and renal responses. Adoption of a healthy diet is a consistent core element of lifestyle modifications that are recommended for mitigation of hypertension. The dietary sodium-to-potassium ratio is recognized as having promising potential in the regulation of blood pressure. In fact, the understanding of the relation between this ratio and blood pressure was documented as a key evidence gap in the 2019 National Academies of Sciences, Engineering, and Medicine report that revised recommended intake levels for both sodium and potassium. Although notable animal and human evidence supports this point, fundamental to developing a specific dietary recommendation for a sodium-to-potassium ratio is a well-designed human intervention trial. The successful translatability of such a trial will require careful consideration of study elements, including the study population, duration, blood pressure measurement, and dietary intervention, among other factors. This paper addresses these decision points and serves as supporting documentation for a research group or organization with the interest and means to address this important data gap, which will undoubtedly be foundational for advancing dietary guidance and would inform the next iteration of Dietary Reference Intakes for sodium and potassium.

Changes in Sexual Desire and Behaviors among UK Young Adults During Social Lockdown Due to COVID-19.

This study examined self-reported changes in young adults' sexual desire and behaviors during the most significant social restrictions imposed to deal with COVID-19. Drawing on a survey of 565 British adults aged 18-32 collected at the peak of social lockdown restrictions, we document an overall decrease in sexual behaviors consistent with abiding by social restrictions. We found that the levels of sexual desire reported by women (but not men) decreased compared with reports of pre-lockdown levels. Participants in serious relationships reported more increases in sexual activity than people who were single or dating casually, and there were significant differences according to gender and sexual orientation. The perceived impact of subjective wellbeing of people with high sociosexuality scores was disproportionately associated with social lockdown but there was no effect for general health. Thus, the impact on sexuality and general wellbeing should be considered by policymakers when considering future social restrictions related to COVID-19 or other public health emergencies.

Executive functions underlying multiplicative reasoning: problem type matters.

We investigated the extent to which inhibition, updating, shifting, and mental-attentional capacity (M-capacity) contribute to children's ability to solve multiplication word problems. A total of 155 children in Grades 3-6 (8- to 13-year-olds) completed a set of multiplication word problems at two levels of difficulty: one-step and multiple-step problems. They also received a reading comprehension test and a battery of inhibition, updating, shifting, and M-capacity measures. Structural equation modeling showed that updating mediated the relationship between multiplication performance (controlling for reading comprehension score) and latent attentional factors M-capacity and inhibition. Updating played a more important role in predicting performance on multiple-step problems than did age, whereas age and updating were equally important predictors on one-step problems. Shifting was not a significant predictor in either model. Implications of proposing executive function updating as a mediator between mathematical cognition and chronological age and attention resources are discussed.

The Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes Study (ACCORD-MIND): rationale, design, and methods.

Type 2 diabetes mellitus and cognitive impairment are 2 of the most common chronic conditions found in persons aged > or = 60 years. Clinical studies have shown a greater prevalence of global cognitive impairment, incidence of cognitive decline, and incidence of Alzheimer disease in patients with type 2 diabetes. To date, there have been no randomized trials of the effects of long-term glycemic control on cognitive function and structural brain changes in patients with type 2 diabetes. The primary aim of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Memory in Diabetes Study (ACCORD-MIND) is to test whether there is a difference in the rate of cognitive decline and structural brain change in patients with diabetes treated with standard-care guidelines compared with those treated with intensive-care guidelines. This comparison will be made in a subsample of 2,977 patients with diabetes participating in the ongoing ACCORD trial, a clinical trial sponsored by the National Heart, Lung, and Blood Institute (NHLBI) with support from the National Institute on Aging (NIA). Data from this ACCORD substudy on the possible beneficial or adverse effects of intensive treatment on cognitive function will be obtained from a 30-minute test battery, administered at baseline and 20-month and 40-month visits. In addition, full-brain magnetic resonance imaging will be performed on 630 participants at baseline and at 40 months to assess the relation between the ACCORD treatments and structural brain changes. The general aim of ACCORD-MIND is to determine whether the intensive treatment of diabetes, a major risk factor for Alzheimer disease and vascular dementia, can reduce the early decline in cognitive function that could later evolve into more cognitively disabling conditions. This report presents the design, rationale, and methods of the ACCORD-MIND substudy.

Sex-specific but not sexually explicit: pupillary responses to dressed and naked adults.

Dilation of the pupils is an indicator of an observer's sexual interest in other people, but it remains unresolved whether this response is strengthened or diminished by sexually explicit material. To address this question, this study compared pupillary responses of heterosexual men and women to naked and dressed portraits of male and female adult film actors. Pupillary responses corresponded with observers' self-reported sexual orientation, such that dilation occurred during the viewing of opposite-sex people, but were comparable for naked and dressed targets. These findings indicate that pupillary responses provide a sex-specific measure, but are not sensitive to sexually explicit content.

Heterosexual, Homosexual, and Bisexual Men's Pupillary Responses to Persons at Different Stages of Sexual Development.

This study investigated whether pupil size during the viewing of images of adults and children reflects the sexual orientation of heterosexual, homosexual, and bisexual men (n = 100, Mage = 22). More specifically, we explored whether this measure corresponds with sexual age preferences for adults over children in nonpedophilic men. In general, results across three experiments, in which observers freely viewed or rated the sexual appeal of person images, suggest that pupil dilation to sexual stimuli is an indicator of sexual orientation toward adults. Heterosexual men's pupils dilated most strongly to adults of the other sex, homosexual men dilated most strongly to adults of the same sex, and bisexual men showed an intermediate pattern. Dilation to adults was substantially stronger than dilation to younger age groups. Sexual appeal ratings for images of adults and children also correlated with pupil responses, suggesting a direct link between pupil dilation and sexual interest. These findings provide support for pupil dilation as a measure of sex- and age-specific sexual preferences.

The mental-attention Tai Chi effect with older adults.

BACKGROUND: Tai Chi practice has some fitness, wellness, and general cognitive effects in older adults. However, benefits of Tai Chi on specific mental-attentional executive processes have not been investigated previously. We studied older Canadian adults of Chinese and non-Chinese origin and from low socioeconomic areas. METHODS: Sixty-four adults (51-87 years old) took part in a 16-week Tai Chi program. There were two groups: Chinese-background (n = 35) and Non-Chinese-background (n = 29). They received four mental-attention executive tasks before and after the 16-week period. These tasks measured visuospatial reasoning, mental-attentional activation (working memory), attentional inhibition, and balance between these attention factors (field-dependence-independence). RESULTS: Chinese participants showed significant gain on Figural Intersections Task (mental-attentional capacity), Antisaccade (attentional inhibition), and Matrix Reasoning (fluid intelligence measure). Both groups evidenced gain on the Water Level Task (attentional balance). CONCLUSIONS: These gains suggest that Tai Chi can improve mental-attentional vigilance and executive control, when practitioners are sufficiently motivated to pursue this practice, and apply themselves (as our Chinese participants seem to have done). We found that Tai Chi enhanced mental attentional executives in the Chinese sample. The largely negative results with Non-Chinese participants might be explained by less strong motivation and by the relatively short Tai Chi practice period, which contrasts with the prior familiarity with Tai Chi of the Chinese participants.

Faculty-Mentor-in-Rez: The development of a new faculty-in-residence model.

Faculty-in-residence programs have long been touted as a successful way to provide for both intentional and casual out-of-the-classroom interactions between students and faculty. Despite research on the benefits to students and to faculty of such programs, academic commitments and lack of clarity around the role of live-in faculty has made recruiting of faculty a challenge. This case study provides an account of how McGill University, a publicly-funded, research-intensive university in Montreal, Canada, undertook the development and implementation of a new faculty-in-residence model that honored the long history of faculty living in McGill's residences, provided structured opportunities for faculty-student engagement, and reflected McGill's unique residence culture.

Improving the learning of clinical reasoning through computer-based cognitive representation.

OBJECTIVE: Clinical reasoning is usually taught using a problem-solving approach, which is widely adopted in medical education. However, learning through problem solving is difficult as a result of the contextualization and dynamic aspects of actual problems. Moreover, knowledge acquired from problem-solving practice tends to be inert and fragmented. This study proposed a computer-based cognitive representation approach that externalizes and facilitates the complex processes in learning clinical reasoning. The approach is operationalized in a computer-based cognitive representation tool that involves argument mapping to externalize the problem-solving process and concept mapping to reveal the knowledge constructed from the problems. METHODS: Twenty-nine Year 3 or higher students from a medical school in east China participated in the study. Participants used the proposed approach implemented in an e-learning system to complete four learning cases in 4 weeks on an individual basis. For each case, students interacted with the problem to capture critical data, generate and justify hypotheses, make a diagnosis, recall relevant knowledge, and update their conceptual understanding of the problem domain. Meanwhile, students used the computer-based cognitive representation tool to articulate and represent the key elements and their interactions in the learning process. RESULTS: A significant improvement was found in students' learning products from the beginning to the end of the study, consistent with students' report of close-to-moderate progress in developing problem-solving and knowledge-construction abilities. No significant differences were found between the pretest and posttest scores with the 4-week period. The cognitive representation approach was found to provide more formative assessment. CONCLUSIONS: The computer-based cognitive representation approach improved the learning of clinical reasoning in both problem solving and knowledge construction.