“How can anybody be representative for those kind of people?” Forms of patient representation in health research, and why it is always contestable

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.Different discourses that co-exist within the world of patient and public involvement in health and social care mirror a tangle of historical, social, political and theoretical roots. These range from the radical activism, born of civil rights movements, to a more passive model in which patients are the recipients of information. This paper explores the concept of ‘representation’ and the ways the concept is used by people serving as ‘patient’ or ‘lay’ representatives in a range of roles within research projects, funding bodies and academic institutions. We address the issue of why the representativeness of those involved is contestable. Drawing on qualitative research and engaged practice as well as on literature from social and political sciences we question how people conceptualise their own and their fellows' acts of representation. In doing this we identify nine different conceptualisations of what it is to represent and use these to explore how judgements are made about what can count as legitimate forms of representation.The PhD study “Public and Patient Involvement in Theory and in Practice” was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. We would also like to acknowledge the generous contributions of time and thought made by study participants and the Peninsula Public involvement Group (PenPIG)

Power spectrum analysis of bursting cells in area MT in the behaving monkey

It is widely held that visual cortical neurons encode information primarily in their mean firing rates. Some proposals, however, emphasize the information potentially available in the temporal structure of spike trains (Optican and Richmond, 1987; Bialek et al., 1991), in particular with respect to stimulus-related synchronized oscillations in the 30–70 Hz range (Eckhorn et al., 1988; Gray et al., 1989; Kreiter and Singer, 1992) as well as via bursting cells (Cattaneo et al., 1981a; Bonds, 1992). We investigate the temporal fine structure of spike trains recorded in extrastriate area MT of the trained macaque monkey, a region that plays a major role in processing motion information. The data were recorded while the monkey performed a near- threshold direction discrimination task so that both physiological and psychophysical data could be obtained on the same set of trials (Britten et al., 1992). We identify bursting cells and quantify their properties, in particular in relation to the behavior of the animal. We compute the power spectrum and the distribution of interspike intervals (ISIs) associated with individual spike trains from 212 cells, averaging these quantities across similar trials. (1) About 33% of the cells have a relatively flat power spectrum with a dip at low temporal frequencies. We analytically derive the power spectrum of a Poisson process with refractory period and show that it matches the observed spectrum of these cells. (2) About 62% of the cells have a peak in the 20–60 Hz frequency band. In about 10% of all cells, this peak is at least twice the height of its base. The presence of such a peak strongly correlates with a tendency of the cell to respond in bursts, that is, two to four spikes within 2–8 msec. For 93% of cells, the shape of the power spectrum did not change dramatically with stimulus conditions. (3) Both the ISI distribution and the power spectrum of the vast majority of bursting cells are compatible with the notion that these cells fire Poisson-distributed bursts, with a burst-related refractory period. Thus, for our stimulus conditions, no explicitly oscillating neuronal process is required to yield a peak in the power spectrum. (4) We found no statistically significant relationship between the peak in the power spectrum and psychophysical measures of the monkeys' performance on the direction discrimination task

Timescales of spike-train correlation for neural oscillators with common drive

We examine the effect of the phase-resetting curve (PRC) on the transfer of correlated input signals into correlated output spikes in a class of neural models receiving noisy, super-threshold stimulation. We use linear response theory to approximate the spike correlation coefficient in terms of moments of the associated exit time problem, and contrast the results for Type I vs. Type II models and across the different timescales over which spike correlations can be assessed. We find that, on long timescales, Type I oscillators transfer correlations much more efficiently than Type II oscillators. On short timescales this trend reverses, with the relative efficiency switching at a timescale that depends on the mean and standard deviation of input currents. This switch occurs over timescales that could be exploited by downstream circuits

4-π-Photocyclization of 1,2-Dihydropyridazines: An Approach to Bicyclic 1,2-Diazetidines with Rich Synthetic Potential.

The 4-π-photocyclization of a range of 1,2-dihydropyridazines is described, generating bicyclic 1,2-diazetidines in high yields on multigram scale. The key bicyclic 1,2-diazetidines are versatile synthetic intermediates and were easily converted into a range of novel derivatives, including functionalized 1,2-diazetidines, cyclobutenes, cyclobutanes, and 1,3-dienes

Predator decline leads to decreased stability in a coastal fish community

Fisheries exploitation has caused widespread declines in marine predators. Theory predicts that predator depletion will destabilise lower trophic levels, making natural communities more vulnerable to environmental perturbations. However, empirical evidence has been limited. Using a community matrix model, we empirically assessed trends in the stability of a multispecies coastal fish community over the course of predator depletion. Three indices of community stability (resistance, resilience and reactivity) revealed significantly decreasing stability concurrent with declining predator abundance. The trophically downgraded community exhibited weaker top-down control, leading to predator-release processes in lower trophic levels and increased susceptibility to perturbation. At the community level, our results suggest that high predator abundance acts as a stabilising force to the naturally stochastic and highly autocorrelated dynamics in low trophic species. These findings have important implications for the conservation and management of predators in marine ecosystems and provide empirical support for the theory of predatory control

Exploring perceived barriers, drivers, impacts and the need for evaluation of public involvement in health and social care research: a modified Delphi study

Mixed method, three-phase, modified Delphi technique, conducted as part of a larger MRC multiphase project: http://www.piiaf.org.ukThis is a freely-available open access publication. Please cite the published version which is available via the DOI link in this recordAbstract Objective To explore areas of consensus and conflict in relation to perceived public involvement (PI) barriers and drivers, perceived impacts of PI and ways of evaluating PI approaches in health and social care research. Background Internationally and within the UK the recognition of potential benefits of PI in health and social care research is gathering momentum and PI is increasingly identified by organisations as a prerequisite for funding. However, there is relatively little examination of the impacts of PI and how those impacts might be measured. Design Mixed method, three-phase, modified Delphi technique, conducted as part of a larger MRC multiphase project. Sample Clinical and non-clinical academics, members of the public, research managers, commissioners and funders. Findings This study found high levels of consensus about the most important barriers and drivers to PI. There was acknowledgement that tokenism was common in relation to PI; and strong support for the view that demonstrating the impacts and value of PI was made more difficult by tokenistic practice. PI was seen as having intrinsic value; nonetheless, there was clear support for the importance of evaluating its impact. Research team cohesion and appropriate resources were considered essential to effective PI implementation. Panellists agreed that PI can be challenging, but can be facilitated by clear guidance, together with models of good practice and measurable standards. Conclusions This study is the first to present empirical evidence of the opinions voiced by key stakeholders on areas of consensus and conflict in relation to perceived PI barriers and drivers, perceived impacts of PI and the need to evaluate PI. As such it further contributes to debate around best practice in PI, the potential for tokenism and how best to evaluate the impacts of PI. These findings have been used in the development of the Public Involvement Impact Assessment Framework (PiiAF), an online resource which offers guidance to researchers and members of the public involved in the PI process.The study was supported by the Medical Research Council's Methodology Research Programme [G0902155/93948]

Exploring areas of consensus and conflict around values underpinning public involvement in health and social care research: A modified Delphi study

Objective: There is growing interest in the potential benefits of public involvement (PI) in health and social care research. However, there has been little examination of values underpinning PI or how these values might differ for different groups with an interest in PI in the research process. We aimed to explore areas of consensus and conflict around normative, substantive and process-related values underpinning PI. Design: Mixed method, three-phase, modified Delphi study, conducted as part of a larger multiphase project. Setting: The UK health and social care research community. Participants: Stakeholders in PI in research, defined as: clinical and non-clinical academics, members of the public, research managers, commissioners and funders; identified via research networks, online searches and a literature review. Results: We identified high levels of consensus for many normative, substantive and process-related issues. However, there were also areas of conflict in relation to issues of bias and representativeness, and around whether the purpose of PI in health and social care research is to bring about service change or generate new knowledge. There were large differences by group in the percentages endorsing the ethical justification for PI and the argument that PI equalises power imbalances. With regard to practical implementation of PI, research support infrastructures were reported as lacking. Participants reported shortcomings in the uptake and practice of PI. Embedding PI practice and evaluation in research study designs was seen as fundamental to strengthening the evidence base. Conclusions: Our findings highlight the extent to which PI is already embedded in research. However, they also highlight a need for 'best practice' standards to assist research teams to understand, implement and evaluate PI. These findings have been used in developing a Public Involvement Impact Assessment Framework (PiiAF), which offers guidance to researchers and members of the public involved in the PI process