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Translational research needs to show value through impact on measures that matter to the public, including health and societal benefits. To this end, the Translational Science Benefits Model (TSBM) identified four categories of impact: Clinical, Community, Economic, and Policy. However, TSBM offers limited guidance on how these areas of impact relate to equity. Central to the structure of our Center for American Indian and Alaska Native Diabetes Translation Research are seven regional, independent Satellite Centers dedicated to community-engaged research. Drawing on our collective experience, we provide empirical evidence about how TSBM applies to equity-focused research that centers community partnerships and recognizes Indigenous knowledge. For this special issue – “Advancing Understanding and Use of Impact Measures in Implementation Science” – our objective is to describe and critically evaluate gaps in the fit of TSBM as an evaluation approach with sensitivity to health equity issues. Accordingly, we suggest refinements to the original TSBM Logic model to add: 1) community representation as an indicator of providing community partners “a seat at the table” across the research life cycle to generate solutions (innovations) that influence equity and to prioritize what to evaluate, and 2) assessments of the representativeness of the measured outcomes and benefits.
Adaptive decision-making is necessary to sustain functional independence. Maladaptive decisions are among the most prevalent features of psychological and neurological disorders. One crucial aspect of decision-making involves arbitrating between exploring new avenues with risky but potentially lucrative outcomes or exploiting prior knowledge and endorsing predictable outcomes. Balancing this dichotomy creates a behavioral tension that shapes all decisions and is termed the exploration-exploitation trade-off. This trade-off has been linked to reward and affective drives and associated neural circuitry as well as neuropsychological dysfunction. However, the neural mechanisms underlying the exploration-exploitation trade-off are still uncertain, due to the scarcity of literature and the heterogeneity of paradigms. This study aimed to systematically quantify and disambiguate neuroanatomical correlates of the exploration-exploitation tradeoff in a normative adult sample. These findings provide a necessary starting point for future investigations of this fundamental aspect of decision-making across clinical populations, with potential implications for assessment and intervention.
We used the effect-location method of meta-analysis to analyze data from 10 functional neuroimaging studies investigating the exploration-exploitation tradeoff in non-clinical samples. We analyzed the location and frequency of significant neural activations across studies for both explorative and exploitative decisions and characterized them as core and non-core regions. Core activations were defined as those reported in over 50% of studies. Secondary and tertiary activations were defined as those reported in 40% and 30% of studies, respectively. The present review was conducted in accordance with the guidelines of the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
The results revealed that explorative and exploitative choice behaviours differed markedly with respect to associated patterns of task-related brain activity. Exploration was associated with activity in brain regions implicated in externally directed, goal-based attentional processing and reward-related uncertainty, mainly tapping bilateral parietal and frontal circuitry, with relatively high consistency across studies. A core explorative network was revealed, consisting of activity in the frontal polar cortex, the dorsal anterior cingulate cortex, the bilateral medial frontal gyrus, the bilateral precuneus, and the bilateral intraparietal sulcus. Secondary and tertiary regions were also detected, including the bilateral anterior insula, the left precentral gyrus, the bilateral superior frontal gyrus, the right inferior frontal gyrus, the left supplementary motor area, the bilateral superior parietal lobule, and the bilateral thalamus. Exploitation was associated with brain regions implicated in internally directed processes including reward valuation, motivation, and memory. Core exploitative activations included the ventromedial prefrontal cortex, the bilateral anterior cingulate cortex, and the bilateral orbitofrontal cortex. Secondary and tertiary activations included the bilateral hippocampus, the left middle temporal gyrus, the bilateral angular gyrus, the left posterior cingulate cortex, the left superior frontal gyrus, and the bilateral superior temporal gyrus.
The exploration-exploitation trade-off provides a novel paradigmatic approach to study adaptive and maladaptive decision-making behaviour in humans. Our findings support the neural dichotomization of exploration and exploitation and illuminate potential neural networks underlying this fundamental feature of decision-making. Understanding these mechanistic networks opens a new avenue of inquiry into decision-making deficits in clinical populations, including neurodegenerative, neurodevelopmental, and neuropsychiatric syndromes.
Objectives: Youth and young adults with pediatric-onset multiple sclerosis (MS) are vulnerable to executive dysfunction; however, some patients do not demonstrate functional deficits despite showing abnormalities on structural magnetic resonance imaging (MRI). Cognitively intact adults with MS have shown enhanced activation patterns relative to healthy controls on working memory tasks. We aim to evaluate whether cognitively preserved pediatric-onset MS patients engage compensatory recruitment strategies to facilitate age-normative performance on a task of working memory. Methods: Twenty cognitively preserved patients (mean age=18.7±2.7 years; 15 female) and 20 age- and sex-matched controls (mean age=18.5±2.9 years; 15 female) underwent neuropsychological testing and 3.0 Tesla MRI, including structural and functional acquisitions. Patterns of activation during the Alphaspan task, a working memory paradigm with two levels of executive control demand, were examined via whole-brain and region of interest (ROI) analyses. Results: Across all participants, lower accuracy and greater activation of regions implicated in working memory were observed during the high demand condition. MS patients demonstrated 0.21 s longer response time than controls. ROI analyses revealed enhanced activation for pediatric-onset MS patients relative to controls in the right middle frontal, left paracingulate, right supramarginal, and left superior parietal gyri during the low executive demand condition, over and above differences in response time. MS patients also demonstrated heightened activation in the right supramarginal gyrus in the high executive demand condition. Conclusions: Our findings suggest that pediatric-onset MS patients may engage compensatory recruitment strategies during working memory processing. (JINS, 2019, 25, 432–442)
Pollen grains and spores, plant macrofossils, and sponge spicules from a 7.2-m sediment core from Jackson Pond dating back to 20,000 yr B.P. are the basis for new interpretations of vegetational, limnological, and climatic changes in central Kentucky. During the full-glacial interval (20,400 to 16,800 yr B.P.) upland vegetation was closed spruce forest with jack pine as a subdominant. Aquatic macrophyte and sponge assemblages indicate that the site was a relatively deep, open pond with low organic productivity. During late-glacial time (16,800 to 11,300 yr B.P.) spruce populations continued to dominate while jack pine declined and sedge increased as the vegetation became a more open, taiga-like boreal woodland. Between 11,300 and 10,000 yr B.P., abundances of spruce and oak pollen oscillated reciprocally, possibly reflecting the Younger Dryas oscillation as boreal taxa underwent a series of declines and increases at the southern limit of their ranges before becoming extirpated and replaced by deciduous forest. In the early Holocene (10,000 to 7300 yr B.P.) a mesic deciduous woodland developed; it was replaced by xeric oak-hickory forest during the middle Holocene between 7300 and 3900 yr B.P. Grass increased after 3900 yr B.P., indicating that the presettlement vegetation mosaic of mixed deciduous forest and prairie (the “Kentucky Barrens”) became established in central Kentucky after the Hypsithermal interval. Sponge spicules increased in number during the Holocene, reflecting reduced water depths in the pond. Sediment infilling, as well as climatic warming and the expansion of fringing shrub thickets, increased nutrient and habitat availability for freshwater sponges.