Introduction to the cognitive hospital.

The third industrial revolution has radically impacted the transformation of hospitals. Through the adoption of key digital technologies, hospitals have become more accessible, flexible, organised, responsive and able to deliver more personalised care. The digitalisation of patient health records, one of the most remarkable achievements to date in healthcare management, has enabled new opportunities, including the idea of hospitals evolving to become artificially intelligent. In parallel, the adoption of electronic and mobile internet technologies in hospitals has introduced new structural concepts, seeing a variety of terms blossom such as 'smart', 'intelligent', 'green' and 'liquid'. Now in the early fourth industrial revolution, driven by AI and internet-of-things technologies, this article unveils a new concept adapted to the upcoming era.

Immediate and delayed effects of suppression and mindfulness as emotion regulation strategies.

BACKGROUND & OBJECTIVES: Emotion regulation is an integral component of multiple physical and psychological functions, and problems with emotion regulation are thought to be involved with the development of psychological disorders. Most laboratory research on emotion regulation has been limited to investigating short-term impact during a single session. DESIGN & METHODS: In the current study, we investigated the potential delayed consequences of the short-term use of two emotion regulation strategies: mindfulness and suppression. To do so, a two-session design was implemented, with 56 undergraduate participants viewing images under various regulation instructions at Time 1, returning one week later for a recognition memory test for these images at Time 2. Images were rated for valence and arousal at both time points. RESULTS: We hypothesized that images encoded mindfully would elicit lower levels of anxiety upon re-exposure, while suppression would increase levels of anxiety. Results did not support original hypotheses: although participants reported being calmer and happier at re-exposure, this effect did not vary by strategy. High-anxiety participants reported higher arousal levels regardless of Instruction condition or Time Point. CONCLUSIONS: These findings suggest that short-term use of emotion regulation does not impact feelings of calmness long-term, when exposed to anxiety-provoking stimuli.

Age Differences in Negative, but Not Positive, Rumination.

OBJECTIVES: The main objective of this study was to determine whether there are age differences in positive and negative repetitive thought (ie, rumination). METHOD: Young adults (ages 19-39; n = 114) and older adults (ages 60-85; n = 88) completed measures of negative and positive rumination. Bayesian analyses were used to determine whether age differences were present for both negative (young > old) and positive (old > young) rumination. RESULTS: There was extremely strong evidence for age differences in negative rumination, with lower scores in older adults. In contrast, the evidence was in favor of the null hypothesis for positive rumination. DISCUSSION: Age-related positivity is better characterized as decreased dwelling on the meaning of negative moods, rather than increased attention to positive ones.

Empathic Understanding: Benefits of Perspective-Taking and Facial Mimicry Instructions are Mediated by Self-Other Overlap.

The current study sought to better understand the utility of two strategies - perspective-taking and facial mimicry - proposed to increase empathic responding. Thirty-seven female participants were presented an interpersonal situation (a betrayal) that would elicit the use of empathic responding to achieve conflict resolution between friends. Each participant was given instructions to partake in either perspective-taking, facial mimicry, or to remain neutral (control condition). The results demonstrated that individuals who engaged in perspective-taking reported significantly higher state empathy than the control condition, but there was no significant difference in state empathy between the mimicry and control condition. Also, those who engaged in either strategy reported significantly higher self-other overlap relative to those not instructed to engage in a particular strategy. Importantly, self-other overlap mediated the association between the instructional sets and state empathy. Both strategies are arguably means of enhancing interpersonal understanding.

Episodic future thought: contributions from working memory.

The ability to imagine hypothetical events in one's personal future is thought to involve a number of constituent cognitive processes. We investigated the extent to which individual differences in working memory capacity contribute to facets of episodic future thought. College students completed simple and complex measures of working memory and were cued to recall autobiographical memories and imagine future autobiographical events consisting of varying levels of specificity (i.e., ranging from generic to increasingly specific and detailed events). Consistent with previous findings, future thought was related to analogous measures of autobiographical memory, likely reflecting overlapping cognitive factors supporting both past and future thought. Additionally, after controlling for autobiographical memory, residual working memory variance independently predicted future episodic specificity. We suggest that when imagining future events, working memory contributes to the construction of a single, coherent, future event depiction, but not to the retrieval or elaboration of event details.

Information content moderates positivity and negativity biases in memory.

Two experiments examined the impact of encoding conditions and information content in memory for positive, neutral, and negative pictures. We examined the hypotheses that the positivity effect in memory (i.e., a bias in favor of positive or against negative information in later life) would be reduced when (a) pictures were viewed under structured as opposed to unstructured conditions, and (b) contained social as opposed to nonsocial content. Both experiments found that the positivity effect observed with nonsocial stimuli was absent with social stimuli. In addition, little evidence was obtained that encoding conditions affected the strength of the positivity effect. We argue that some types of social stimuli may engage different types of processing than nonsocial stimuli, perhaps encouraging self-referential processing that engages attention and supports memory. This processing may then conflict with the goal-driven, top-down processing that is hypothesized to drive the positivity effect. Thus, our results identify further boundary conditions associated with the positivity effect in memory, arguing that stimulus factors as well as situational goals may affect its occurrence. Further research awaits to determine if this effect is specific to all social stimuli or specific subsets.

The illusion of the positive: the impact of natural and induced mood on older adults' false recall.

Recent research suggests that affective and motivational processes can influence age differences in memory. In the current study, we examine the impact of both natural and induced mood state on age differences in false recall. Older and younger adults performed a version of the Deese-Roediger-McDermott (DRM; Roediger & McDermott, 1995 , Journal of Experimental Psychology: Learning, Memory, and Cognition, 21, 803) false memory paradigm in either their natural mood state or after a positive or negative mood induction. Results indicated that, after accounting for age differences in basic cognitive function, age-related differences in positive mood during the testing session were related to increased false recall in older adults. Inducing older adults into a positive mood also exacerbated age differences in false memory. In contrast, veridical recall did not appear to be systematically influenced by mood. Together, these results suggest that positive mood states can impact older adults' information processing and potentially increase underlying cognitive age differences.

Mood, motivation, and misinformation: aging and affective state influences on memory.

Normative age differences in memory have typically been attributed to declines in basic cognitive and cortical mechanisms. The present study examined the degree to which dominant everyday affect might also be associated with age-related memory errors using the misinformation paradigm. Younger and older adults viewed a positive and a negative event, and then were exposed to misinformation about each event. Older adults exhibited a higher likelihood than young adults of falsely identifying misinformation as having occurred in the events. Consistent with expectations, strength of the misinformation effect was positively associated with dominant mood, and controlling for mood eliminated any age effects. Also, motivation to engage in complex cognitive activity was negatively associated with susceptibility to misinformation, and susceptibility was stronger for negative than for positive events. We argue that motivational processes underlie all of the observed effects, and that such processes are useful in understanding age differences in memory performance.

Longitudinal relationships between resources, motivation, and functioning.

OBJECTIVES: We investigated how fluctuations and linear changes in health and cognitive resources influence the motivation to engage in complex cognitive activity and the extent to which motivation mediated the relationship between changing resources and cognitively demanding activities. METHOD: Longitudinal data from 332 adults aged 20-85 years were examined. Motivation was assessed using a composite of Need for Cognition and Personal Need for Structure and additional measures of health, sensory functioning, cognitive ability, and self-reported activity engagement. RESULTS: Multilevel modeling revealed that age-typical changes in health, sensory functions, and ability were associated with changes in motivation, with the impact of declining health on motivation being particularly strong in older adulthood. Changes in motivation, in turn, predicted involvement in cognitive and social activities as well as changes in cognitive ability. Finally, motivation was observed to partially mediate the relationship between changes in resources and cognitively demanding activities. DISCUSSION: Our results suggest that motivation may play an important role in determining the course of cognitive change and involvement in cognitively demanding everyday activities in adulthood.

Changes in mindfulness, well-being, and sleep quality in college students through taijiquan courses: a cohort control study.

OBJECTIVES: This study sought to determine whether participants in taijiquan classes would report increases in mindfulness greater than that of a comparison group, and whether changes in mindfulness were associated with improvements in mood, perceived stress, self-regulatory self-efficacy, and sleep quality. DESIGN: The study design was quasi-experimental with repeated measures. SETTINGS/LOCATION: The study was set in a midsized public university. SUBJECTS: Students aged 18-48 years old enrolled in 15-week courses of either taijiquan (n=76) or special recreation (control group, n=132). INTERVENTION: Chen-style taijiquan classes were offered 2 times per week for 50 minutes each time. OUTCOME MEASURES: Self-report of mindfulness (Five Facet Mindfulness Questionnaire), mood (Four Dimensional Mood Scale), perceived stress (Perceived Stress Scale), self-regulatory self-efficacy (Self-regulatory Self-Efficacy Scale), and sleep quality (Pittsburgh Sleep Quality Index). RESULTS: Increases in total mindfulness scores occurred only in the taijiquan group, not in the control group. All well-being variables showed a pattern of improvement in the taijiquan group, with either stability or decline over time in the control group. Increases in mindfulness were significantly correlated with improvements on all well-being measures and with sleep quality. CONCLUSIONS: Relative to a recreation control group, taijiquan classes for college students are associated with increased mindfulness and improved sleep quality, mood, and perceived stress, but not self-regulatory self-efficacy. Randomized control design studies are needed to substantiate the causal role of taijiquan exercise in the development of mindfulness and associated improvements in well-being.

Cognitive consequences of expressive regulation in older adults.

Previous research has suggested that older and young adults are equally able to regulate their outward expressions of emotion and that the regulation of emotional expression in younger adults results in decreased memory for the emotional stimulus. In the current study, we examined whether older adults show this same memory effect. Older and young adults viewed positive and negative emotional pictures under instructions to view the pictures naturally, enhance their facial expressions, or suppress their facial expressions. Older and young adults showed equivalent outward regulation of expression, but suppressing their emotional expressions led to reduced memory for emotional stimuli only in the young adults. The results suggest that older and young adults are achieving control of their expressions through different mechanisms or strategies.

Task demands moderate stereotype threat effects on memory performance.

Previous research has demonstrated that older adults' memory performance is adversely affected by the explicit activation of negative stereotypes about aging. In this study, we examined the impact of stereotype threat on recognition memory, with specific interest in (a) the generalizability of previously observed effects, (b) the subjective experience of memory, and (c) the moderating effects of task demands. Older participants subjected to threat performed worse than did those in a nonthreat condition but only when performance constraints were high (i.e., memory decisions had to be made within a limited time frame). This effect was reflected in the subjective experience of memory, with participants in this condition having a lower ratio of "remember" to "know" responses. The absence of threat effects when constraints were minimal provides important boundary information regarding stereotype influences on memory performance.

Age differences in proactive interference, working memory, and abstract reasoning.

It has been hypothesized that older adults are especially susceptible to proactive interference (PI) and that this may contribute to age differences in working memory performance. In young adults, individual differences in PI affect both working memory and reasoning ability, but the relations between PI, working memory, and reasoning in older adults have not been examined. In the current study, young, old, and very old adults performed a modified operation span task that induced several cycles of PI buildup and release as well as two tests of abstract reasoning ability. Age differences in working memory scores increased as PI built up, consistent with the hypothesis that older adults are more susceptible to PI, but both young and older adults showed complete release from PI. Young adults' reasoning ability was best predicted by working memory performance under high PI conditions, replicating M. Bunting (2006). In contrast, older adults' reasoning ability was best predicted by their working memory performance under low PI conditions, thereby raising questions regarding the general role of susceptibility to PI in differences in higher cognitive function among older adults.

Age-related changes in neural activity during performance matched working memory manipulation.

A long-standing assumption in the cognitive aging literature is that performance on working memory (WM) tasks involving serial recall is relatively unaffected by aging, whereas tasks that require the rearrangement of items prior to recall are more age-sensitive. Previous neuroimaging studies of WM have found age-related increases in neural activity in frontoparietal brain regions during simple maintenance tasks, but few have examined whether there are age-related differences that are specific to rearranging WM items. In the current study, older and younger adults' brain activity was monitored using functional magnetic resonance imaging (fMRI) as they performed WM tasks involving either maintenance or manipulation (letter-number sequencing). The paradigm was developed so that performance was equivalent across age groups in both tasks, and the manipulation condition was not more difficult than the maintenance condition. In younger adults, manipulation-related increases in activation occurred within a very focal set of regions within the canonical brain WM network, including left posterior prefrontal cortex and bilateral inferior parietal cortex. In contrast, older adults showed a much wider extent of manipulation-related activation within this WM network, with significantly increased activity relative to younger adults found within bilateral PFC. The results suggest that activation and age-differences in lateral PFC engagement during WM manipulation conditions may reflect strategy use and controlled processing demands rather than reflect the act of manipulation per se.

Viewing instructions impact emotional memory differently in older and young adults.

The current study examines how the instructions given during picture viewing impact age differences in incidental emotional memory. Previous research has suggested that older adults' memory may be better when they make emotional rather than perceptual evaluations of stimuli and that their memory may show a positivity bias in tasks with open-ended viewing instructions. Across two experiments, participants viewing photographs either received open-ended instructions or were asked to make emotionally focused (Experiment 1) or perceptually focused (Experiment 2) evaluations. Emotional evaluations had no impact on older adults' memory, whereas perceptual evaluations reduced older adults' recall of emotional, but not of neutral, pictures. Evidence for the positivity effect was sporadic and was not easier to detect with open-ended viewing instructions. These results suggest that older adults' memory is best when the material to be remembered is emotionally evocative and they are allowed to process it as such.

Natural history of antibodies to deamidated gliadin peptides and transglutaminase in early childhood celiac disease.

INTRODUCTION: Gliadin proteins play a key role in the pathogenesis of celiac disease; however, as a screen for celiac disease, anti-gliadin antibody testing has been replaced by the more sensitive and specific serological assays for transglutaminase autoantibodies (TGAA). A new generation of anti-gliadin antibody assays has been developed to detect synthetic, deamidated homologous gliadin peptides (DGP) with high sensitivity and specificity. METHODS: Sera were collected prospectively from children with an increased risk for celiac disease as part of an ongoing study at Denver, and studied for the development of celiac autoimmunity. We investigated the high-performance DGP antibody assay in 50 TGAA-positive children both before the development of celiac autoimmunity and following the institution of a gluten-free diet to determine the relationship of DGP antibodies to TGAA. TGAA were measured by an in-house radioassay. RESULTS: DGP antibodies and TGAA parallel each other over the period of years children were studied. DGP antibodies resolved sooner than TGAA in subjects on a gluten-free diet. DGP antibodies appeared earlier than TGAA in 9 children. CONCLUSIONS: Measuring DGP antibodies may be more useful than TGAA in monitoring children on a gluten-free diet. DGP antibodies can precede the appearance of TGAA in some at-risk children.

Impact of celiac autoimmunity on children with type 1 diabetes.

OBJECTIVE: Children with type 1 diabetes (T1DM) are at increased risk for celiac disease (CD); however, the benefits of screening for IgA tissue transglutaminase autoantibodies (TG), a marker for CD, are unclear. STUDY DESIGN: We compared 71 screening-identified TG+ with 63 matched TG- children with TIDM. Growth, bone density, and diabetes control measures were obtained. RESULTS: The group was 10 +/- 3 years of age, 46% male, with TIDM for 4 +/- 3 years. Z scores for weight (0.3 +/- 1 vs 0.7 +/- 0.8, P = .024), body mass index (BMI) (0.3 +/- 0.9 vs 0.8 +/- -0.8, P = .005), and midarm circumference (0.3 +/- 1.1 vs 0.6 +/- 0.9, P = .031) were lower in the TG+ group. Bone mineral density and diabetes control measures were similar. When limiting the analysis to the 35 TG+ subjects with biopsy changes of CD, the BMI Z score was lower than the control group (0.4 +/- 0.9 vs 0.7 +/- 0.7, P = .05). CONCLUSIONS: In children with TIDM, screening-identified evidence of CD is associated with altered body composition, but not bone mineral density or diabetes control. Further study is needed to determine the benefit of early diagnosis and treatment of CD in TIDM children.

Age differences in item manipulation span: the case of letter-number sequencing.

The authors report 2 experiments in which they examined age differences in working memory tasks involving complex item manipulation (i.e., letter-number sequencing). In Experiment 1, age differences on tasks involving item manipulation were not greater than age differences on tasks requiring recall of items in the order in which they appeared, suggesting that older adults do not have difficulty with item manipulation per se. In Experiment 2, slower presentation rates increased age differences in item manipulation spans, although age differences at the fastest rate may be attributed to differences in strategy use. In both experiments, age differences were largest when participants were most likely to be remembering familiar sequences, suggesting that older adults may have difficulties dampening the representations of such sequences once they are activated.

Saying versus touching: age differences in short-term memory are affected by the type of response.

We examined whether the type of response used to report items recalled from short-term memory affects the age difference in verbal and spatial memory spans. Younger and older adults viewed either a series of letters or a series of locations in a grid, and then they reported their memory for the items either vocally or by using a touch screen. Overall, age differences were larger for spatial memory spans than for verbal memory spans, replicating previous results. Changing the response modality affected only older adults' verbal spans, which were approximately one item higher with a vocal response than with a manual response. This resulted in a smaller age difference for verbal items reported vocally than for any other condition. The results can best be explained by age-related difficulties in both spatial processing and in dealing with stimulus-response incongruity.