Marieke de Vries

Fitting decisions: Mood and intuitive versus deliberative decision strategies

We investigated the influence of the compatibility between mood and decision strategies on the subjective value of a decision outcome. Several studies have provided evidence for the idea that a sad mood induces people to analyse information carefully, probably fitting well with a deliberative decision strategy. In a happy mood, people tend to act more strongly on their feelings, probably fitting well with an intuitive decision strategy. However, sometimes the situation demands the use of decision strategies that seem incompatible with mood states. We expected that decision makers would value a decision outcome higher in the case of a fit between mood and decision strategy than in the case of a non-fit. After a mood manipulation, participants were instructed to decide either based on their first affective reaction or after deliberation. Results confirmed our expectations: fitting decisions enhanced the subjective value of a decision outcome.

Commercial cow milk contains physically stable extracellular vesicles expressing immunoregulatory TGF-β.

Scope Extracellular vesicles, including exosomes, have been identified in all biological fluids and rediscovered as an important part of the intercellular communication. Breast milk also contains extracellular vesicles and the proposed biological function is to enhance the antimicrobial defense in newborns. It is, however, unknown whether extracellular vesicles are still present in commercial milk and, more importantly, whether they retained their bioactivity. Here, we characterize the extracellular vesicles present in semi-skimmed cow milk available for consumers and study their effect on T cells. Methods and Results Extracellular vesicles from commercial milk were isolated and characterized. Milk-derived extracellular vesicles contained several immunomodulating miRNAs and membrane protein CD63, characteristics of exosomes. In contrast to RAW 267.4 derived extracellular vesicles the milk-derived extracellular vesicles were extremely stable under degrading conditions, including low pH, boiling and freezing. Milk-derived extracellular vesicles were easily taken up by murine macrophages in vitro. Furthermore, we found that they can facilitate T cell differentiation towards the pathogenic Th17 lineage. Using a (CAGA)12-luc reporter assay we showed that these extracellular vesicles carried bioactive TGF-β, and that anti-TGF-β antibodies blocked Th17 differentiation. Conclusion Our findings show that commercial milk contains stable extracellular vesicles, including exosomes, and carry immunoregulatory cargo. These data suggest that the extracellular vesicles present in commercial cow milk remains intact in the gastrointestinal tract and exert an immunoregulatory effect.

Oral administration of bovine milk derived extracellular vesicles attenuates arthritis in two mouse models.

SCOPE This study shows the effect of bovine milk derived extracellular vesicles (BMEVs) on spontaneous polyarthritis in IL-1Ra-deficient mice and collagen-induced arthritis. METHODS AND RESULTS BMEVs were isolated from semi-skimmed milk by ultracentrifugation and the particle size was around 100 nm by dynamic light scattering and electron microscopy. BMEVs expressed exosome marker CD63, immunoregulatory microRNAs (miR-30a, -223, -92a), and milk-specific beta-casein and beta-lactoglobulin mRNA. In vitro, PKH-67-labeled BMEVs were taken up by RAW264.7, splenocytes, and intestinal cells as determined by flow cytometry and confocal microscopy. IL-1Ra(-/-) mice received BMEVs by daily oral gavage starting at wk 5 till 15 after birth and collagen-induced arthritis mice via their drinking water starting 1 wk before immunization till day 40. Macroscopically, BMEV treatment delayed the onset of arthritis and histology showed diminished cartilage pathology and bone marrow inflammation in both models. BMEV treatment also reduced the serum levels of MCP-1 and IL-6 and their production by splenic cells. BMEV treatment diminished the anticollagen IgG2a levels, which was accompanied by reduced splenic Th1 (Tbet) and Th17 (RORγT) mRNA. CONCLUSION This is the first report that oral delivery of BMEVs ameliorates experimental arthritis and this warrants further research to determine whether this beneficial effect can be seen in rheumatoid arthritis patients.

Happiness Cools the Warm Glow of Familiarity Psychophysiological Evidence That Mood Modulates the Familiarity-Affect Link

People often prefer familiar stimuli, presumably because familiarity signals safety. This preference can occur with merely repeated old stimuli, but it is most robust with new but highly familiar prototypes of a known category (beauty-in-averageness effect). However, is familiarity always warm? Tuning accounts of mood hold that positive mood signals a safe environment, whereas negative mood signals an unsafe environment. Thus, the value of familiarity should depend on mood. We show that compared with a sad mood, a happy mood eliminates the preference for familiar stimuli, as shown in measures of self-reported liking and physiological measures of affect (electromyographic indicator of spontaneous smiling). The basic effect of exposure on preference and its modulation by mood were most robust for prototypes (category averages). All this occurs even though prototypes might be more familiar in a happy mood. We conclude that mood changes the hedonic implications of familiarity cues.

The Unconscious Thought Effect in Clinical Decision Making: An Example in Diagnosis

The unconscious thought effect refers to improved judgments and decisions after a period of distraction. The authors studied the unconscious thought effect in a complex and error-prone part of clinical decision making: diagnosis. Their aim was to test whether conscious versus unconscious processing influenced diagnosis of psychiatric cases. They used case descriptions from the DSM-IV casebook. Half of the participants were randomly assigned to the conscious-processing-condition (i.e., consciously thinking about the information they read in the case description), the other half to the unconscious-processing condition (i.e., performing an unrelated distracter task). The main dependent measure was the total number of correct classifications. Compared to conscious processing, unconscious processing significantly increased the number of correct classifications. The results show the potential merits of unconscious processing in diagnostic decision making.

Domains of quality of life: results of a three-stage Delphi consensus procedure among patients, family of patients, clinicians, scientists and the general public

PurposeOur key objective is to identify the core domains of health-related quality of life (QoL). Health-related QoL utility scales are commonly used in economic evaluations to assess the effectiveness of health-care interventions. However, health-care interventions are likely to affect QoL in a broader sense than is quantifiable with traditional scales. Therefore, measures need to go beyond these scales. Unfortunately, there is no consensus in the scientific literature on the essential domains of QoL.MethodsWe conducted a three-stage online Delphi consensus procedure to identify the key domains of health-related QoL. Five stakeholder groups (i.e., patients, family of patients, clinicians, scientists and general public) were asked, on three consecutive occasions, what they perceive as the most important domains of health-related QoL. An analysis of existing (health-related) QoL and well-being measurements formed the basis of the Delphi-procedure.ResultsIn total, 42 domains of QoL were judged, covering physical, mental and social aspects. All participants rated ‘self-acceptance’, ‘self-esteem’ and ‘good social contacts’ as essential. Strikingly, mental and social domains are perceived as more essential than physical domains across stakeholders groups.ConclusionsIn traditionally used health-related QoL utility measures, physical domains like ‘mobility’ are prominently present. The Delphi-procedure shows that health-related QoL (utility) scales need to put sufficient emphasis on mental and social domains to capture aspects of QoL that are essential to people.

Combining deliberation and intuition in patient decision support

OBJECTIVE To review the strengths and weaknesses of deliberative and intuitive processes in the context of patient decision support and to discuss implications for decision aid (DA) design. METHODS Conceptual review of the strengths and weaknesses of intuitive and analytical decision making and applying these findings to the practice of DA design. RESULTS DAs combine several important goals: providing information, helping to clarify treatment related values, supporting preference construction processes, and facilitating more active engagement in decision making. Many DAs encourage patients to approach a decision analytically, without solid theoretical or empirical grounding for this approach. Existing research in other domains suggests that both intuition and deliberation may support decision making. We discuss implications for patient decision support and challenge researchers to determine when combining these processes leads to better outcomes. CONCLUSIONS Intuitive and analytical decision processes may have complementary effects in achieving the desired outcomes of patient decision support. PRACTICE IMPLICATIONS DA developers should be aware that tools solely targeted at supporting deliberation may limit DA effectiveness and harm preference construction processes. Patients may be better served by combined strategies that draw on the strengths and minimize the weaknesses of both deliberative and intuitive processes.

Patients are dissatisfied with information provision: perceived information provision and quality of life in prostate cancer patients

To determine the satisfaction with information received by prostate cancer survivors and associations with health‐related quality of life (HRQoL) and illness perception.

Mood and the Attitude–Behavior Link The Happy Act on Impulse, the Sad Think Twice

Attitude–behavior relations can be based on belief-based or associative processes. Understanding the basic regulatory mechanisms that determine which type of process guides behavior in a specific situation is of crucial importance for predicting behavior. In this article, the authors tested mood states as a moderator. In two studies, associative and belief-based measures for attitudes were administered in a preliminary session. In a second session, mood was manipulated and behavior toward the attitude object involved was observed. Consistent with predictions, the results showed that in happy mood states, associative, but not belief-based measures of attitudes predicted behavior, whereas in sad mood states belief-based, but not associative measures of attitudes predicted behavior. The authors conclude that mood moderates which evaluative process, belief-based or associative, regulates behavior.

Values clarification in a decision aid about fertility preservation: does it add to information provision?

BackgroundWe aimed to evaluate the effect of a decision aid (DA) with information only compared to a DA with values clarification exercise (VCE), and to study the role of personality and information seeking style in DA-use, decisional conflict (DC) and knowledge.MethodsTwo scenario-based experiments were conducted with two different groups of healthy female participants. Dependent measures were: DC, knowledge, and DA-use (time spent, pages viewed, VCE used). Respondents were randomized between a DA with information only (VCE-) and a DA with information plus a VCE(VCE+) (experiment 1), or between information only (VCE-), information plus VCE without referral to VCE(VCE+), and information plus a VCE with specific referral to the VCE, requesting participants to use the VCE(VCE++) (experiment 2). In experiment 2 we additionally measured personality (neuroticism/conscientiousness) and information seeking style (monitoring/blunting).ResultsExperiment 1. There were no differences in DC, knowledge or DA-use between VCE- (n=70) and VCE+ (n=70). Both DAs lead to a mean gain in knowledge from 39% at baseline to 73% after viewing the DA. Within VCE+, VCE-users (n=32, 46%) reported less DC compared to non-users. Since there was no difference in DC between VCE- and VCE+, this is likely an effect of VCE-use in a self-selected group, and not of the VCE per se. Experiment 2. There were no differences in DC or knowledge between VCE- (n=65), VCE+ (n=66), VCE++ (n=66). In all groups, knowledge increased on average from 42% at baseline to 72% after viewing the DA. Blunters viewed fewer DA-pages (R=0.38, p<.001). More neurotic women were less certain (R=0.18, p<.01) and felt less supported in decision making (R=0.15, p<.05); conscientious women felt more certain (R=-0.15, p<.05) and had more knowledge after viewing the DA (R=0.15, p<.05).ConclusionsBoth DAs lead to increased knowledge in healthy populations making hypothetical decisions, and use of the VCE did not improve knowledge or DC. Personality characteristics were associated to some extent with DA-use, information seeking styles with aspects of DC. More research is needed to make clear recommendations regarding the need for tailoring of information provision to personality characteristics, and to assess the effect of VCE use in actual patients.