Behavioural and neural modulation of win-stay but not lose-shift strategies as a function of outcome value in Rock, Paper, Scissors

Competitive environments in which individuals compete for mutually-exclusive outcomes require rational decision making in order to maximize gains but often result in poor quality heuristics. Reasons for the greater reliance on lose-shift relative to win-stay behaviour shown in previous studies were explored using the game of Rock, Paper, Scissors and by manipulating the value of winning and losing. Decision-making following a loss was characterized as relatively fast and relatively inflexible both in terms of the failure to modulate the magnitude of lose-shift strategy and the lack of significant neural modulation. In contrast, decision-making following a win was characterized as relatively slow and relatively flexible both in terms of a behavioural increase in the magnitude of win-stay strategy and a neural modulation of feedback-related negativity (FRN) and stimulus-preceding negativity (SPN) following outcome value modulation. The win-stay / lose-shift heuristic appears not to be a unified mechanism, with the former relying on System 2 processes and the latter relying on System 1 processes. Our ability to play rationally appears more likely when the outcome is positive and when the value of wins are low, highlighting how vulnerable we can be when trying to succeed during competition

Failure generates impulsivity only when outcomes cannot be controlled

Verbruggen, Chambers, Lawrence & McLaren (2017) recently challenged the view that individuals act with greater caution following the experience of a negative outcome by showing that a gambled loss resulted in faster reaction time on the next trial. Over three experiments, we replicate and establish the boundary conditions of this effect in the context of a simple game (Rock, Paper, Scissors). Choice responding against unexploitable opponents replicated the link between failure and faster responding. However, individuals with high win-rates against exploitable opponents initiated slower rather than faster responding following loss. The data suggest that the link between failure and impulsivity is limited to contexts where participants cannot exert control over outcomes

Developing an Easy Read version of the Adult Social Care Outcomes Toolkit (ASCOT)

Background: This paper reports the experiences of developing and pre-testing an Easy Read version of the Adult Social Care Outcomes Toolkit (ASCOT) for self-report by people with intellectual disabilities. Method: The study has combined survey development and pre-testing methods with approaches to create accessible information for people with intellectual disabilities. A working group assisted researchers in identifying appropriate question formats, pictures and wording. Focus groups and cognitive interviews were conducted to test various iterations of the instrument. Results: Substantial changes were made to the questionnaire, which included changes to illustrations, the wording of question stems and response options. Conclusions: The process demonstrated the benefits of involving people with intellectual disabilities in the design and testing of data collection instruments. Adequately adapted questionnaires can be useful tools to collect information from people with intellectual disabilities in survey research; however its limitations must be recognised

Evaluation of the personal health budget pilot programme

1. The personal health budget initiative is a key aspect of personalisation across health care services in England. Its aim is to improve patient outcomes, by placing patients at the centre of decisions about their care. Giving people greater choice and control, with patients working alongside health service professionals to develop and execute a care plan, given a known budget, is intended to encourage more responsiveness of the health and care system. 2. The personal health budget programme was launched by the Department of Health in 2009 after the publication of the 2008 Next Stage Review. An independent evaluation was commissioned alongside the pilot programme with the aim of identifying whether personal health budgets ensured better health and care outcomes when compared to conventional service delivery and, if so, the best way for personal health budgets to be implemented

Implementing personal health budgets within substance misuse services [final report]

Executive summary 1. The personal health budget initiative is a key aspect of personalisation across health care services in England. Its aim is to improve patient outcomes, by placing patients at the centre of decisions about their care. 2. In 2009 the Department of Health invited PCTs to become pilot sites to join a programme which would explore the opportunities offered by personal health budgets. The Department of Health commissioned an independent evaluation to run alongside the pilot programme to provide information on how personal health budgets are best implemented, where and when they are most appropriate, and what support is required for individuals. 3. Two pilot sites within the pilot programme explored whether personal health budgets had an impact on outcomes and experiences compared to conventional service delivery among individuals with substance misuse problems. Study design and methodology 4. The evaluation adopted a longitudinal approach, and included people with drug and/or alcohol addiction. 5. The study used a controlled trial with a pragmatic design to compare the experiences of people receiving a personal health budget with the experiences of people continuing under the current substance misuse treatment support arrangements. After applying initial selection criteria, in one pilot site people were randomised into the personal health budget group or a control group. In the second pilot site, the personal health budget group was recruited from patients of those health care professionals in the pilot offering budgets, and a control group was recruited from patients of nonparticipating health care professionals. 6. A mixed design was followed where both quantitative and qualitative methodologies were used to explore patient outcomes and experiences, service use and costs, as well as the experiences of those implementing the initiative. In total, an active sample of 166 participants was recruited: 119 in the personal health budget group and 47 in the control group. Within the active study sample, 55 participants had drug and alcohol addictions and 111 participants had an alcohol addiction only. 7. The qualitative analysis involved interviews with personal health budget holders and organisational representatives. Data were analysed using the framework approach, with the data organised by themes according to the topic guides used in the interviews. 8. The difference-in-difference approach was used to explore whether personal health budgets had an impact on an individual’s quality of life and relapse rates. The analysis subtracted an individual’s follow-up outcome scores from their baseline score. Due to the small sample size, the analysis did not include exploring difference-in-difference multivariate models and therefore we were unable to control for confounding baseline differences. The content of support plans 9. Among the personal health budget group, 103 support plans were returned from the two pilot sites. In terms of the size of the budget, 41 budgets were worth between £1,000 and £5,000 per year, while 4 budgets were worth more than £10,000. 2 10. The majority of care/support plans were managed notionally. While one of the pilot sites did have approval to offer direct payments, we did not find evidence this deployment was offered during the pilot programme. 11. Residential detox was the largest single cost category. The more innovative uses of the personal health budget included driving lessons, alternative therapies, leisure activities and educational courses. Enabling people to access community detox rather than residential detox could also be regarded as an innovative use of their budget. The impact of personal health budgets on relapse rates, quality of life and service quality 12. The shortened version of the Alcohol Use Disorders Identification Test (AUDIT-C) was used to detect signs of hazardous and harmful drinking. Difference-in-difference analysis indicated that individuals in the personal health budget group had reduced their excessive drinking at follow-up compared to those in the control group. Similar results were found with the change in drug consumption at followup. 13. Difference-in-difference analysis indicated that there were greater improvements in care-related quality of life (ASCOT) and psychological well-being (GHQ12) for individuals in the personal health budget group compared to those in the control group, although the difference was not statistically significant. 14. Individuals in the personal health budget group were more satisfied with the help paid for by the budget and the care/support planning process than those receiving conventional services. 15. While the quantitative results highlighted the positive impact of receiving a personal health budget, firm conclusions around the impact of personal health budgets compared to conventional service delivery could not be made, due to the small sample size. Views from patients 16. Qualitative in-depth interviews indicated that personal health budgets had a positive impact on service quality, relationships with health professionals and views on what could be achieved compared with conventional service detox delivery. 17. The importance of effective implementation was highlighted, both in terms of providing the necessary information to enable budget holders to make an informed choice and also to minimise any delays in the process of obtaining and using a budget. Individuals reported that delays could potentially lead to anxiety and distress. 18. A list of suggestions of possible uses of personal health budgets would have been useful during the support/care planning stage. 19. Personal budget holders reported a lack of after-care services available with this treatment route which could potentially have a longer-term impact on relapse rates. This desire for post-detox care to prevent relapse was especially prevalent at follow-up, when patients had completed their detoxification and required relapse prevention services. 20. Individuals receiving conventional detox services expressed more negative views of the relationship they had with health professionals and their experiences of services. Views from the system 21. Organisational representatives believed that personal health budgets had a positive impact on outcomes for budget holders: the way they accessed services, and to a certain extent the content or 3 quality of those services. Organisational representatives attributed these impacts to the personal health budgets enabling: increased choice and control for budget holders; increased flexibility; encouraging innovation and creativity; greater ‘person-centred’ care/support planning; and the opportunity to reduce costs by accessing alternative services or providers of services. 22. A number of challenges within the implementation process were mentioned by organisational representatives. These included: the length of time required to conduct the care/support planning process; the time point at which a personal health budget should be introduced; deciding what can and cannot be included, in particular considering whether the budget should be used for relapse prevention; managing attitudes to risk and the cultural change required for patients in the system; the logistics of managing multi-agencies involved in a person’s care; and establishing integration between services and creating a jointly-funded budget. Recommendations for policy and practice 23. A number of recommendations can be made regarding a possible roll-out of personal health budgets within the area of substance misuse from the results of this study: Personal health budgets increased service satisfaction, facilitated a positive relationship with health professionals and improved quality of life supporting a wider roll-out. The budget-holders we interviewed emphasised the value of information and guidance from operational representatives about the size and operation of their budgets, including what services were covered. Direct payments were viewed as playing a critical role in the success of personal health budgets for people with substance misuse problems. However, managing the anxiety and practical challenges around offering this deployment option may need consideration

How can MAX help local authorities to use social care data to inform local policy? Maximising the value of survey data in adult social care [MAX] project [Full report]

Executive summary of the MAX working paper - How can MAX help local authorities to use social care data to inform local policy? Maximising the value of survey data in adult social care [MAX] projec

A Physiologically-Based Pharmacokinetic Model for Targeting Calcitriol-Conjugated Quantum Dots to Inflammatory Breast Cancer Cells.

Quantum dots (QDs) conjugated with 1,25 dihydroxyvitamin D3 (calcitriol) and Mucin-1 (MUC-1) antibodies (SM3) have been found to target inflammatory breast cancer (IBC) tumors and reduce proliferation, migration, and differentiation of these tumors in mice. A physiologically-based pharmacokinetic model has been constructed and optimized to match experimental data for multiple QDs: control QDs, QDs conjugated with calcitriol, and QDs conjugated with both calcitriol and SM3 MUC1 antibodies. The model predicts continuous QD concentration for key tissues in mice distinguished by IBC stage (healthy, early-stage, and late-stage). Experimental and clinical efforts in QD treatment of IBC can be augmented by in silico simulations that predict the short-term and long-term behavior of QD treatment regimens

Personal Health Budgets: Process and context following the national pilot programme: Working Paper 2947

The general approach of the current report – in line with process evaluation methods (Moore et al., 2015) – was to learn from (a) the experience of organisational representatives with responsibility for personal health budget policy and practice; and (b) budget holders since the national pilot programme and also (by way of some contrast) from the experiences of new budget holders. In particular, we sought to infer key mechanisms of effect, and reflect on the contexts in which they operated (Pawson and Tilly, 2007). Together, mechanisms and context help us understand why we saw the outcomes of personal health budgets that were found in the national evaluation, and conjecture on how changing context – specifically, post-pilot operation of the policy – might have an impact. Based on the studies to date, the following process factors were expected to be important in determining the success of personal health budgets: * Different budget-setting process * Support planning and review process * The development of the range of services available and availability of providers * The extent of integration between health and social care We explored these issues using a process evaluation approach that involved interviews with both organisational representatives – i.e. people charged with implementing personal health budgets – and with budget holders. Semi-structured interviews were conducted, with topics framed around the hypothesised process factors. Audio-files of the interviews were transcribed verbatim and were analysed using software NVivo 10 for Windows (QSR International Pty Ltd)