Values and value in simulated participant methodology: A global perspective on contemporary practices.

This article has been written for the 40th year of the publication of Medical Teacher. While we celebrate the contribution of simulated participants (SPs) to health professions education through values and value-based learning, we also offer critical reflection on elements of our practice, commencing with language. We argue for the use of the term simulated rather than standardized and acknowledge the dominant role of the SP as patient and the origins of the methodology. These shifts in terms and their implications in practice reflect changes in the conceptualization of SP-based methodology. Recently published standards for those who work with SPs (SP practitioners) are noted as an important milestone in our community's development. We consider contemporary practices addressing the complex notions of values and value in SP-based learning. We simultaneously refer to the work of SPs and SP practitioners. Phases of educational design including identifying learning objectives, scenario design, implementation, feedback and debriefing are used to illustrate methodological shifts. Within each of these phases, there are relational issues that have to date often gone unchecked and are under reported in literature. Finally, using the metaphor of a murmuration, we celebrate contemporary practices of the global SP practitioner community.

Non-human contributions to personality neuroscience: From fish through primates - a concluding editorial overview.

This special issue attempts to integrate personality, psychopathology, and neuroscience as means to improve understanding of specific traits and trait structures in humans. The key strategy is to dive into comparative research using a range of species to provide simple models. This strategy has, as its foundation, the fact that the most basic functions, and their supporting neural systems, are highly conserved in evolution. The papers collected in the issue show that, from fish, through rats, to primates, the homologies in brain systems and underlying functions (despite species-specific forms of expression) allow simpler cases to provide insights into the neurobiology behind more complex ones including human. Our introductory editorial paper to this special issue took a bottom-up approach, starting with the genetics of conserved brain systems and working up to cognition. Here, we deconstruct the different aspects of personality, progressing from more complex ones in primates to least complex in fish. With the primate section, we summarize papers that discuss the factors that contribute to sociability in primates and how they apply to healthy and pathological human personality traits. In the rat section, the focus is driven by psychopathology and the way that "high" strains selected for extreme behaviors can illuminate the neurobiology of motivated responses to environmental cues. The section on fish summarizes papers that look into the most fundamental emotional reactions to the environment that are governed by primitive and conserved brain structures. This raises metatheoretical questions on the nature of traits and to a section that asks "which animals have personalities." We believe that the issue as a whole provides a nuanced answer to this question and shines a new, comparative, light on the interpretation of personality structure and the effects on it of evolution.

U-Pb SHRIMP geochronology data from the eastern Central Kibalian Superterrane, Bomu-Kibalian Craton, northeastern DRC: Implications for the tectonic evolution of the Kilo Terrane.

This brief presents new U-Pb SHRIMP (Sensitive High-Resolution Ion Microprobe) geochronology data on zircons and titanites dated from the gold-rich Kilo Terrane in the eastern Central Kibalian Superterrane, northeastern DRC. Out of 40 rock samples (), only 36 samples produced zircons and titanites suitable for U-Pb SHRIMP dating (-). Raw ion-microprobe SHRIMP analyses of specific zircon/titanite grain-spots returned U-Th-Pb compositions and radiogenic isotope ratios (-), from which age dates (Table 3, Figs 8A-8HH and 13A-F) were derived. With the exception of Table 3, all Tables are presented in the Supplementary Material. The new age dates in this Brief can be used in advancing understanding of the gold metallogeny and implications to exploration targeting for large to giant gold deposits in the Bomu-Kibalian Craton.

Anterior thalamic nuclei neurons sustain memory.

A hippocampal-diencephalic-cortical network supports memory function. The anterior thalamic nuclei (ATN) form a key anatomical hub within this system. Consistent with this, injury to the mammillary body-ATN axis is associated with examples of clinical amnesia. However, there is only limited and indirect support that the output of ATN neurons actively enhances memory. Here, in rats, we first showed that mammillothalamic tract (MTT) lesions caused a persistent impairment in spatial working memory. MTT lesions also reduced rhythmic electrical activity across the memory system. Next, we introduced 8.5 Hz optogenetic theta-burst stimulation of the ATN glutamatergic neurons. The exogenously-triggered, regular pattern of stimulation produced an acute and substantial improvement of spatial working memory in rats with MTT lesions and enhanced rhythmic electrical activity. Neither behaviour nor rhythmic activity was affected by endogenous stimulation derived from the dorsal hippocampus. Analysis of immediate early gene activity, after the rats foraged for food in an open field, showed that exogenously-triggered ATN stimulation also increased Zif268 expression across memory-related structures. These findings provide clear evidence that increased ATN neuronal activity supports memory. They suggest that ATN-focused gene therapy may be feasible to counter clinical amnesia associated with dysfunction in the mammillary body-ATN axis.

Ketamine and neuroticism: a double-hit hypothesis of internalizing disorders.

Psychiatric disorders can often be viewed as extremes of personality traits. The primary action of drugs that ameliorate these disorders may, thus, be to alter the patient's position on a relevant trait dimension. Here, we suggest that interactions between such trait dimensions may also be important for disorder. Internalizing disorders show important differences in terms of range of activity and speed of response of medications. Established antidepressant and anxiolytic medications are slow in onset and have differing effects across different internalizing disorders. In contrast, low-dose ketamine is rapidly effective and improves symptom ratings in all internalizing disorders. To account for this, we propose a "double hit" model for internalizing disorders: generation (and maintenance) require two distinct forms of neural dysfunction to coincide. One hit, sensitive to ketamine, is disorder-general: dysfunction of a neural system linked to high levels of the personality trait of neuroticism. The other hit is disorder-specific: dysfunction of one of a set of disorder-specific neural modules, each with its own particular pattern of sensitivity to conventional drugs. Our hypothesis applies only to internalizing disorders. So, we predict that ketamine will be effective in simple phobia and (perhaps partially) in anorexia nervosa, but would make no such prediction about other disorders where neuroticism might also be important secondarily (e.g. attention deficit hyperactivity disorder and schizophrenia).

Does behavioural inhibition system dysfunction contribute to Attention Deficit Hyperactivity Disorder?

The Reinforcement Sensitivity Theory of Personality has as its main foundation a Behavioural Inhibition System (BIS), defined by anxiolytic drugs, in which high trait sensitivity should lead to internalising, anxiety, disorders. Conversely, it has been suggested that low BIS sensitivity would be a characteristic of externalising disorders. BIS output should lead to increased arousal and attention as well as behavioural inhibition. Here, therefore, we tested whether an externalising disorder, Attention Deficit Hyperactivity Disorder (ADHD), involves low BIS sensitivity. Goal-Conflict-Specific Rhythmicity (GCSR) in an auditory Stop Signal Task is a right frontal EEG biomarker of BIS function. We assessed children diagnosed with ADHD-I (inattentive) or ADHD-C (combined) and healthy control groups for GCSR in: a) an initial smaller study in Dunedin, New Zealand (population ~120,000: 15 control, 10 ADHD-I, 10 ADHD-C); and b) a main larger one in Tehran, Iran (population ~9 [city]-16 [metropolis] million: 27 control, 18 ADHD-I, 21 ADHD-C). GCSR was clear in controls (particularly at 6-7 Hz) and in ADHD-C (particularly at 8-9 Hz) but was reduced in ADHD-I. Reduced attention and arousal in ADHD-I could be due, in part, to BIS dysfunction. However, hyperactivity and impulsivity in ADHD-C are unlikely to reflect reduced BIS activity. Increased GCSR frequency in ADHD-C may be due to increased input to the BIS. BIS dysfunction may contribute to some aspects of ADHD (and potentially other externalising disorders) and to some differences between the ADHD subtypes but other prefrontal systems (and, e.g. dopamine) are also important.

An improved human anxiety process biomarker: characterization of frequency band, personality and pharmacology.

Anxiety disorders are among the most common mental illness in the western world with a major impact on disability. But their diagnosis has lacked objective biomarkers. We previously demonstrated a human anxiety process biomarker, goal-conflict-specific electroencephalography (EEG) rhythmicity (GCSR) in the stop-signal task (SST). Here we have developed and characterized an improved test appropriate for clinical group testing. We modified the SST to produce balanced numbers of trials in clearly separated stop-signal delay groups. As previously, right frontal (F8) GCSR was extracted as the difference in EEG log Fourier power between matching stop and go trials (that is, stop-signal-specific power) of a quadratic contrast of the three delay values (that is, power when stopping and going are in balanced conflict compared with the average of when stopping or going is greater). Separate experiments assessed drug sensitivity (n=34) and personality relations (n=59). GCSR in this new SST was reduced by three chemically distinct anxiolytic drugs (administered double-blind): buspirone (10 mg), triazolam (0.25 mg) and pregabalin (75 mg); had a frequency range (4-12 Hz) consistent with rodent model data; and positively correlated significantly with neuroticism and nonsignificantly with trait anxiety scores. GCSR, measured in our new form of the SST, should be suitable as a biomarker for one specific anxiety process in the testing of clinical groups and novel drugs and in the development of measures suitable for individual diagnosis.

Comparison between the behavioural effects of septal and hippocampal lesions: a review.

The literature on the behavioural effects of septal and hippocampal lesions is classified according to behavioural paradigm. The effects of the two kinds of lesion are summarized and compared to each other. A 'septo-hippocampal syndrome,' consisting of the effects common to both lesions, is delineated, and divergences between the effects of the two lesions are noted.

Alzheimer's dementia produces a loss of discrimination but no increase in rate of memory decay in delayed matching to sample.

Patients diagnosed with senile dementia of the Alzheimer type (SDAT) were compared with control subjects on a computerized delayed matching to sample task. Performance was assessed with a measure of discriminability at zero delay and a measure of rate of forgetting--these are the two parameters of an exponential function derived from extensive animal testing. The SDAT group showed significantly poorer discriminability at zero delay than controls but equivalent rates of forgetting over a 32-sec delay. These data suggest that SDAT may have little effect on the decay rate of the short term (or 'primary') memory trace and may instead affect encoding, initial storage or retrieval mechanisms. The effects of SDAT on this task are consistent with previous results with anticholinergic agents in rats.

Effects of long-term administration of anxiolytics on reticular-elicited hippocampal rhythmical slow activity.

Buspirone is effective in treating clinical anxiety but, unlike classical anxiolytics, does not have anti-convulsant, sedative or muscle relaxant side-effects and does not interact with GABA. Buspirone may also differ from classical anxiolytics in requiring a period of 2 weeks or more to achieve its full therapeutic action. It has previously been shown that all anxiolytic drugs, including buspirone, reduce the frequency of reticular-elicited hippocampal rhythmical slow activity (RSA). The present experiments tested whether the time course of the effect of buspirone on rhythmical slow activity differed from that of the anxiolytic benzodiazepine chlordiazepoxide. Rats, implanted with reticular stimulation electrodes and subicular recording electrodes, received three intraperitoneal injections per day of buspirone (2.5 mg/kg), chlordizepoxide (5 mg/kg) or saline for 45 days. Both buspirone and chlordiazepoxide reduced the frequency of rhythmical slow activity on the first day of testing and Ro15-1788 (10 mg/kg) blocked the effects of chlordiazepoxide but not buspirone. There was no increase in the effect of buspirone with time. These results showed that, if the effect of anxiolytic drugs on rhythmical slow activity provides any basis for their clinical action, then some additional factors are required to explain both the delayed action of buspirone and the immediate action of classical anxiolytic drugs.

The interaction of serotonin depletion with anxiolytics and antidepressants on reticular-elicited hippocampal RSA.

Hippocampal rhythmical slow activity (RSA) can be elicited by stimulation of the midbrain reticular formation. Buspirone, chlordiazepoxide and imipramine are all anxiolytic and have all been shown to decrease the frequency of RSA. All these compounds have been suggested to affect, directly or indirectly, 5-HT metabolism and function. The present experiments tested the possibility that buspirone, chlordiazepoxide and imipramine reduce RSA frequency via 5-HT1A autoreceptors. Rats received buspirone (10 mg/kg), chlordiazepoxide (5 mg/kg) and imipramine (30 mg/kg) after 5-HT depletion with p-chlorophenylalanine (pCPA, 100 mg/kg/day for 3 days or 350 mg/kg/day for 2 days) or after pretreatment with 5-HTP (40 mg/kg, to replete 5-HT) as well as pCPA. The frequency-reducing effects produced by buspirone and chlordiazepoxide were unchanged by either dose of pCPA, whereas the frequency-reducing effect of imipramine was completely eliminated by the high dose of pCPA. Pindolol, but not beta-blockers (a combination of metoprolol and ICI118,551), was able to block the effect of imipramine on RSA frequency. Pindolol has been reported to block the effects of buspirone but not chlordiazepoxide. These data suggest that: (1) buspirone obtains its frequency-reducing effects via pre- or post-synaptic 5-HT1A receptors rather than 5-HT1A autoreceptors; (2) chlordiazepoxide obtains its frequency-reducing effect via benzodiazepine receptors and GABA with no direct or indirect involvement of 5-HT systems; and (3) imipramine obtains its frequency-reducing effect by increasing the availability of 5-HT at 5-HT1A receptors which are not autoreceptors.

Electrophysiological properties of the human N-type Ca2+ channel: I. Channel gating in Ca2+, Ba2+ and Sr2+ containing solutions.

We have characterized the properties of the human N-type Ca2+ channel produced by the stable co-expression of the alpha(1B-1), alpha(2b)delta and beta(1b) subunits. The channel displayed the expected pharmacology with respect to the toxins omega-CTx-GVIA and omega-CTx-MVIIC, which depressed currents in a voltage-independent fashion. We characterized a variety of biophysical properties of the channel under conditions in which either Ca2+, Ba2+ or Sr2+ was the sole extracellular divalent ion. In all three ions, current-voltage relationships revealed that the channel was clearly high-voltage activated. Current activation was significantly slower in Ca2+ than either Sr2+ or Ba2+. Construction of conductance-voltage relationships from tail current measurements indicated that the channel was more high-voltage activated in Ca2+ than in either Sr2+ or Ba2+. The rank order of current amplitude at +4 mV was Ba2+ > Sr2+ > or = Ca2+. Elevation of the extracellular concentration of Ba2+ increased maximal current amplitude and shifted the current-voltage relationship to the right. In all three ions channel inactivation was complex consisting of three distinct exponentials. Recovery from inactivation was slow taking several seconds to reach completion. Steady-state inactivation curves revealed that channel inactivation became detectable at holding potentials of between -101 and -91 mV depending on the permeating species. The rank order of mid-points of steady state inactivation was (most negative) Sr2+ > Ca2+ > Ba2+ (most positive). Deactivation of the N-type Ca2+ channel was voltage-dependent and very fast in all three ions. The deactivation rate in Ba2+ was significantly slower than that in both Ca2+ and Sr2+, however the voltage-dependence of deactivation rate was indistinguishable in all three ions.

Neurochemically dissimilar anxiolytic drugs have common effects on hippocampal rhythmic slow activity.

Previous experiments have shown that anxiolytic drugs reduce the frequency of hippocampal rhythmic slow activity, induced by high frequency stimulation of the reticular formation and flatten the function relating threshold septal stimulation to the frequency of driven rhythmic slow activity. All of the drugs involved are known to augment GABAergic transmission. The present experiments investigated the effects of the novel anxiolytic compound buspirone which, unlike conventional anxiolytics, does not interact with GABA, yet is a clinically effective anxiolytic. Buspirone (0.156-40 mg/kg, i.p.) was found to reduce the frequency of reticular-elicited rhythmic slow activity, in a similar manner to chlordiazepoxide (0.019-20 mg/kg, i.p.). Buspirone did not change the linearity of the voltage-frequency function. Buspirone (10 mg/kg, i.p.) also altered the threshold for septal driving of rhythmic slow activity, in a similar manner to classical anxiolytics. The combination of chlordiazepoxide (5 mg/kg, i.p.) with corticosterone (0.2 mg, s.c.) removed the minor differences between buspirone and chlordiazepoxide in both the septal and reticular tests. These results show that buspirone altered the control of rhythmic slow activity in the hippocampus, in a manner which appeared functionally equivalent to other anxiolytics but which depends on mechanisms which are likely to be neurally and pharmacologically distinct from those of other anxiolytic drugs.

Electrophysiological characterisation of the human N-type Ca2+ channel II: activation and inactivation by physiological patterns of activity.

In a cell line (C2D7) stably expressing the human N-type calcium channel encoded by the subunits alpha1B-a, beta1b, alpha2bdelta, we have analysed the Ca2+ currents produced by a range of action potential-like voltage protocols (APVPs). Such protocols consistently produced robust inward currents that could be eliminated by co-application of the Ca2+ channel blocking ions Cd2+ and La3+. The amplitude, latency to peak and area of the current produced by APVPs was dependent on the precise waveform of voltage protocol employed and the temperature. Short bursts of APVPs applied at 100 Hz produced a depression of the Ca2+ current amplitude which was dependent on the half-width of the APVP employed. In contrast, no frequency-dependent changes in the evoked current kinetics were detected. The amount of current depression seen during an 100 Hz 8 APVP burst was greatly enhanced by increasing the temperature from 22 to 37 degrees C. Alterations to the intracellular Ca2+ buffering capacity suggested that the Ca2+ current depression produced during an APVP train arose, at least in part, from a Ca2+-dependent inactivation of the human N-type Ca2+ channel.

Inhibition of recombinant low-voltage-activated Ca(2+) channels by the neuroprotective agent BW619C89 (Sipatrigine).

T-type Ca(2+) currents were recorded in 2 mM Ca(2+) from HEK 293 cells stably expressing recombinant low-voltage-activated Ca(2+) channel subunits. Current-voltage relationships revealed that these currents were low-voltage activated in nature and could be reversibly antagonised by mibefradil, a known T-type channel blocker. At a test potential of -25 mV alpha(1I)-mediated Ca(2+) currents were rapidly and reversibly inhibited by 1-100 microM BW619C89 (IC(50)=14 microM, Hill coefficient 1.3). In contrast to its actions on N-type Ca(2+) channels, a near IC(50) dose (10 microM) of BW619C89 produced no alterations in either the kinetics or voltage-dependence of T-type currents. In additional single dose experiments, currents mediated by rat alpha(1G), human alpha(1H) or human alpha(1I) channel subunits were also inhibited by BW619C89. Overall our data indicate that T-type Ca(2+) channels are more potently blocked by BW619C89 than either type-II Na(+) channels or N-type Ca(2+) channels. It seems, therefore, that inhibition of low-voltage-activated Ca(2+) channels is likely to contribute to the anticonvulsant and neuroprotective actions of this and related compounds.

Inhibition of human N-type voltage-gated Ca2+ channels by the neuroprotective agent BW619C89.

Human N-type Ca2+ channels were rapidly and reversibly inhibited by 5-100 microM BW619C89 (IC50 = 16.4 microM at Vtest = + 10 mV and Vhold = - 90 mV). In the presence of 20 microM BW619C89, activation kinetics were significantly faster. The degree of inhibition observed was affected by both test and holding potential, indicating state-dependent interactions with the N-type Ca2+ channel.

Electrophysiological characterisation of the human N-type Ca2+ channel III: pH-dependent inhibition by a synthetic macrocyclic polyamine.

The effects of a novel synthetic macrocyclic polyamine (LY310315) were investigated on recombinant human N-type Ca2+ channels stabley expressed in HEK293 cells. LY310315 proved to be a potent and reversible N-type Ca2+ channel antagonist. Inhibition by this compound was dose-dependent with an IC50 of approximately 0.4 microM at pH 7.35. LY310315 blocked very rapidly at all concentrations tested. Upon washout, recovery of the Ca2+ current developed with a time constant of approximately 30 s. Use-dependence in the development of block indicated that voltage-dependent transitions in the channel protein were required to permit significant inhibition. Application of > 100 times the IC50 dose of LY310315 to the interior of the cell produced no detectable Ca2+ current inhibition. LY310315 had no effects on the kinetics of channel activation or deactivation but did slightly slow the rate of macroscopic inactivation observed during a 300 ms test depolarisation. In the presence of LY310315 the activation curve was significantly shallower. This resulted in a shift in the activation midpoint voltage to a more depolarised levels. LY310315-induced inhibition of human N-type channels was strongly dependent on the extracellular pH, with increased potency seen upon extracellular acidification. Although most effective against N-type Ca2+ channels, LY310315 was also found to inhibit both P-type and L-type Ca2+ channels. LY310315 proved to be a weak blocker of Na+ currents, but produced approximately 50% of the K+ currents of AtT20 cells at a concentration of 0.5 microM.

Buspirone affects hippocampal rhythmical slow activity through serotonin1A rather than dopamine D2 receptors.

Buspirone reduces anxiety clinically but, unlike classical anxiolytics, is not muscle relaxant, sedative, anticonvulsant or effective in increasing GABA function. The basis for its clinical action is not known, but action at both dopamine D2 and serotonin1A receptors has been suggested. Buspirone, like classical anxiolytics, produces a general reduction in the frequency of hippocampal rhythmical slow activity elicited by stimulation of the midbrain in the rat. Methysergide (3 mg/kg i.p.), GR38032F (0.3 mg/kg i.p.) and haloperidol (0.2 mg/kg and 2.0 mg/kg i.p.) failed to block this effect of buspirone (10 mg/kg i.p.). Apomorphine (0.3 mg/kg i.p.) had minor effects, but did not produce a general reduction in frequency. Pindolol (2 mg/kg i.p.) produced a small reduction in frequency itself. In the presence of pindolol, buspirone was without effect, while the effect of chlordiazepoxide (5 mg/kg i.p.) was potentiated. These results show that: (a) the similar effects of buspirone and classical anxiolytics such as chlordiazepoxide on reticular-elicited hippocampal rhythmical slow activity are achieved through different mechanisms; (b) the effects of buspirone in this particular test are more likely to depend on its interaction with serotonin1A receptors than its interaction with D2 receptors; and (c) that, as in other tests, buspirone does not act via serotonin2 or serotonin3 receptors.

Reticular elicitation of hippocampal slow waves: common effects of some anxiolytic drugs.

Anxiolytic drugs share many of the common behavioural effects of septal and hippocampal lesions in animals. Gray attributes this to changes which the anxiolytics produce in septal generation of hippocampal rhythmical slow activity. However, lesions of the dorsal ascending noradrenergic bundle reproduce this electrophysiological effect of the anxiolytics while only reproducing part of the behavioural profile of the anxiolytics. The present paper reports what appears to be a second common effect of anxiolytic drugs on the generation of hippocampal slow waves which could underlie their behavioural effects. Freely moving rats, previously implanted with electrodes, received high frequency electrical stimulation of the midbrain reticular formation to elicit hippocampal rhythmic slow activity. The frequency of the slow waves produced increased linearly with increasing stimulation intensity as has been reported previously. A barbiturate (amylobarbitone, 15 mg/kg, i.p.) and three benzodiazepines (chlordiazepoxide, 5 mg/kg; diazepam, 5 mg/kg; alprazolam, 1 mg/kg) all decreased the slope of the voltage-frequency function and decreased overall frequency of slow waves produced. Two antipsychotic drugs (haloperidol, 0.2 mg/kg; chlorpromazine, 2 mg/kg) produced similar behavioural sedation to the anxiolytics but did not decrease either the slope of the voltage-frequency function nor the overall frequency of slow waves. The results show that these barbiturates and benzodiazepines produce a common reduction in the frequency of hippocampal rhythmical slow activity. Given the importance attached to slow waves in current theories of hippocampal function, it is possible that this electrophysiological effect could have some relation to the behavioural effects of these anxiolytic drugs. If the effect can be shown to generalize to other classes of anxiolytic drug it could reflect changes in the substrate for the common effects of anxiolytic drugs on behaviour.