Models of peer support to remediate post-intensive care syndrome: A report developed by the SCCM Thrive International Peer Support Collaborative

Objective: Patients and caregivers can experience a range of physical, psychological, and cognitive problems following critical care discharge. The use of peer support has been proposed as an innovative support mechanism. Design: We sought to identify technical, safety and procedural aspects of existing operational models of peer support, among the Society of Critical Care Medicine Thrive Peer Support Collaborative. We also sought to categorize key distinctions between these models and elucidate barriers and facilitators to implementation. Subjects: 17 Thrive sites from the USA, UK, and Australia were represented by a range of healthcare professionals. Interventions: Via an iterative process of in-person and email/conference calls, members of the Collaborative, defined the key areas on which peer support models could be defined and compared; collected detailed self-reports from all sites; reviewed the information and identified clusters of models. Barriers and challenges to implementation of peer support models were also documented. Results: Within the Thrive Collaborative, six general models of peer support were identified: Community based, Psychologist-led outpatient, Models based within ICU follow-up clinics, Online, Groups based within ICU and Peer mentor models. The most common barriers to implementation were: recruitment to groups, personnel input and training: sustainability and funding, risk management and measuring success. Conclusion: A number of different models of peer support are currently being developed to help patients and families recover and grow in the post-critical care setting

The dynamics of entry, exit and profitability: an error correction approach for the retail industry

We develop a two equation error correction model to investigate determinants of and dynamic interaction between changes in profits and number of firms in retailing. An explicit distinction is made between the effects of actual competition among incumbants, new firms competition and potential competition from firms outside the market. Effects of cost, demand and general income changes on profitability are investigated to gain insight in the role of retailing in the cost, demand and wage inflationary processes. The relative importance of profitability, growth and unemployment as determinants of net entry are studied. The model is tested using a panel data set of 36 Dutch shoptypes covering the 1977–1988 period

Functional mechanisms underlying pleiotropic risk alleles at the 19p13.1 breast-ovarian cancer susceptibility locus

A locus at 19p13 is associated with breast cancer (BC) and ovarian cancer (OC) risk. Here we analyse 438 SNPs in this region in 46,451 BC and 15,438 OC cases, 15,252 BRCA1 mutation carriers and 73,444 controls and identify 13 candidate causal SNPs associated with serous OC (P=9.2 × 10-20), ER-negative BC (P=1.1 × 10-13), BRCA1-associated BC (P=7.7 × 10-16) and triple negative BC (P-diff=2 × 10-5). Genotype-gene expression associations are identified for candidate target genes ANKLE1 (P=2 × 10-3) and ABHD8 (P<2 × 10-3). Chromosome conformation capture identifies interactions between four candidate SNPs and ABHD8, and luciferase assays indicate six risk alleles increased transactivation of the ADHD8 promoter. Targeted deletion of a region containing risk SNP rs56069439 in a putative enhancer induces ANKLE1 downregulation; and mRNA stability assays indicate functional effects for an ANKLE1 3′-UTR SNP. Altogether, these data suggest that multiple SNPs at 19p13 regulate ABHD8 and perhaps ANKLE1 expression, and indicate common mechanisms underlying breast and ovarian cancer risk

A case-only study to identify genetic modifiers of breast cancer risk for BRCA1/BRCA2 mutation carriers

Breast cancer (BC) risk for BRCA1 and BRCA2 mutation carriers varies by genetic and familial factors. About 50 common variants have been shown to modify BC risk for mutation carriers. All but three, were identified in general population studies. Other mutation carrier-specific susceptibility variants may exist but studies of mutation carriers have so far been underpowered. We conduct a novel case-only genome-wide association study comparing genotype frequencies between 60,212 general population BC cases and 13,007 cases with BRCA1 or BRCA2 mutations. We identify robust novel associations for 2 variants with BC for BRCA1 and 3 for BRCA2 mutation carriers, P < 10−8, at 5 loci, which are not associated with risk in the general population. They include rs60882887 at 11p11.2 where MADD, SP11 and EIF1, genes previously implicated in BC biology, are predicted as potential targets. These findings will contribute towards customising BC polygenic risk scores for BRCA1 and BRCA2 mutation carriers

The effect of predictive history on the learning of sub-sequence contingencies

Two experiments demonstrated that the prior predictive history of a cue governs the extent to which that cue engages in sequence learning. Using a serial reaction time task, we manipulated the predictiveness of the stimulus locations (cues) with respect to the location of the stimulus on the next trial (outcome), such that half of the cues were good predictors of their outcomes, whilst the other half were poorer predictors. Following this, all cues were then paired with novel outcomes. Learning about those cues that were previously established as good predictors proceeded more rapidly than learning for those cues previously established as poor predictors. When the simple recurrent network is modified to include a variable associability parameter, the effects are easily modelled

The Influence of Blocking on Overt Attention and Associability in Human Learning

Previous studies have demonstrated a retardation in the rate of novel learning about previously blocked cues as compared to appropriate control cues. We report an experiment investigating whether this retardation in novel learning about a blocked cue is accompanied by a reduction in attention to this cue, as anticipated by attentional theories of associative learning. Consistent with these theories, eye gaze measures revealed a reduction in overt attention to the blocked cue both during the compound training phase of the blocking procedure, and also during novel learning with respect to new outcomes. Moreover, the extent of the bias in overt attention away from blocked cues was positively correlated with the subsequent reduction in rate of novel learning about these cues

Syntactic transfer in artificial grammar learning

In an artificial grammar learning (AGL) experiment, participants were trained with instances of one grammatical structure before completing a test phase in which they were required to discriminate grammatical from randomly created strings. Importantly, the underlying structure used to generate test strings was different from that used to generate the training strings. Despite the fact that grammatical training strings were more similar to nongrammatical test strings than they were to grammatical test strings, this manipulation resulted in a positive transfer effect, as compared with controls trained with nongrammatical strings. It is suggested that training with grammatical strings leads to an appreciation of set variance that aids the detection of grammatical test strings in AGL tasks. The analysis presented demonstrates that it is useful to conceptualize test performance in AGL as a form of unsupervised category learning

Overt Attention and Predictiveness in Human Contingency Learning

Two experiments used eye-tracking procedures to investigate the relationship between attention and associative learning in human participants. These experiments found greater overt attention to cues experienced as predictive of the outcomes with which they were paired, than to cues experienced as nonpredictive. Moreover, this attentional bias persisted into a second training phase when all cues were equally predictive of the outcomes with which they were paired, and it was accompanied by a related bias in the rate of learning about these cues. These findings are consistent with the attentional model of associative learning proposed by Mackintosh (1975), but not with that proposed by Pearce and Hall (1980)