Modelling the impact of referral guideline changes for mild dyskaryosis on colposcopy services in England

Objectives: This model examines the effects of changing referral strategies within the established structure of NHS cervical screening driven colposcopy practice. It considers the effects of the new strategy on colposcopy workload, patient waiting times, and associated costs and health benefits. Methods: By postal survey, the current operational strategies of colposcopy services were established by questionnaire with respect to referral practices and management protocols. After first-cut piloting, and utilising published and original research, a Markovian model was constructed, and the impact of the new strategy was determined on colposcopy workload and patient waiting times for three hypothetical clinic types. Expected costs and benefits of the new policy were assessed through the adaptation of a previous ScHARR cervical screening model. Results: Clinic workload is expected to increase by between 21% and 35% within three years of the policy change, depending on clinic efficiency in other areas; the majority of this impact would be seen within the first year. It is predicted that particularly inefficient clinics would struggle to meet the existing waiting time requirements for women referred with low-grade disease, owing to the increased level of workload seen throughout the patient pathway as a result of the implementation of the new policy. The impact of the new policy can, however, be mitigated through improving the efficiency of existing clinics, by altering policies relating to surveillance of low grade disease, post-treatment follow-up, treatment policy (whether or not treatment is performed at the initial colposcopy visit), and through adherence to national guidelines. A cost-effectiveness analysis using the ScHARR liquid-based cytology model suggests that the policy change is likely to be have a cost per quality-adjusted lifeyear gained of between £1,400 and £5,500 per quality-adjusted life-year gained (excluding the costs of follow-up), which would be deemed acceptable to organisations such as the National Institute for Health and Clinical Excellence

Spaced Retrieval Practice: Can Restudying Trump Retrieval?

We investigated spaced retrieval and restudying in 3 preregistered, online experiments. In all experiments, participants studied 40 Swahili–English word pair translations during an initial study phase, restudied intact pairs or attempted to retrieve the English words to Swahili cues twice in three spaced practice sessions, and then completed a final cued-recall test. All 5 sessions were separated by 2 days. In Experiment 1, we manipulated the response format during retrieval (covert vs. overt) and the test list structure (blocked vs. intermixed covert/overt retrieval trials). A memory rating was required on all trials (retrieval: “Was your answer correct?”; restudy: “Would you have remembered the correct translation?”). Response format had no effect on recall, but surprisingly, final test performance for restudied items exceeded both the overt and covert retrieval conditions. In Experiment 2, we manipulated the requirement to make a memory rating. If a memory rating was required, final test restudy performance exceeded retrieval performance, replicating Experiment 1. However, the pattern was descriptively reversed if no rating was required. In Experiment 3, the memory rating was removed altogether, and we examined recall performance for items restudied versus retrieved once, twice, or thrice. Performance improved with practice, and retrieval performance exceeded restudy performance in all conditions. The reversal of the typical retrieval practice effect observed in Experiments 1 and 2 is discussed in terms of theories of reactivity of memory judgments

The Differential Effect of Anxiety and ADHD Symptoms on Inhibitory Control and Sustained Attention for Threat Stimuli: A Go/No-Go Eye-Movement Study

Objective: This study examined the synergistic effects of ADHD and anxiety symptoms on attention and inhibitory control depending on the emotional content of the stimuli. Method: Fifty-four typically developing individuals (27 children/adolescents and 27 adults) completed an eye-movement based emotional Go/No-Go task, using centrally presented (happy, angry) faces and neutral/symbolic stimuli. Sustained attention was measured through saccade latencies and saccadic omission errors (Go trials), and inhibitory control through saccadic commission errors (No-Go trials). ADHD and anxiety were assessed dimensionally. Results: Elevated ADHD symptoms were associated with more commission errors and slower saccade latencies for angry (vs. happy) faces. In contrast, angry faces were linked to faster saccade onsets when anxiety symptoms were high, and this effect prevailed when both anxiety and ADHD symptoms were high. Conclusion: Social threat impacted performance in individuals with sub-clinical anxiety and ADHD differently. The effects of anxiety on threat processing prevailed when both symptoms were high

Interpretation of ambiguous situations: evidence for a dissociation between social and physical threat in Williams syndrome

There is increasing evidence that Williams syndrome (WS) is associated with elevated anxiety that is non-social in nature, including generalised anxiety and fears. To date very little research has examined the cognitive processes associated with this anxiety. In the present research, attentional bias for non-social threatening images in WS was examined using a dot-probe paradigm. Participants were 16 individuals with WS aged between 13 and 34 years and two groups of typically developing controls matched to the WS group on chronological age and attentional control ability respectively. The WS group exhibited a significant attention bias towards threatening images. In contrast, no bias was found for group matched on attentional control and a slight bias away from threat was found in the chronological age matched group. The results are contrasted with recent findings suggesting that individuals with WS do not show an attention bias for threatening faces and discussed in relation to neuroimaging research showing elevated amygdala activation in response to threatening non-social scenes in WS

Assessment of optic disc photographs for glaucoma by UK optometrists: The Moorfields Optic Disc Assessment Study (MODAS)

Purpose: To assess the ability of UK optometrists to accurately discriminate between stereoscopic photographs of healthy and glaucomatous optic discs. Methods: An online survey, including questions relating to qualification, practice environment, and diagnostic methods was completed by 1256 optometrists. Based on their responses, 208 (17%) were selected to undertake an online disc assessment exercise. Optometrists evaluated the same disc images previously assessed by European ophthalmologists as part of the European Optic Disc Assessment Trial (EODAT); the task was to state if the disc appeared healthy or glaucomatous. There were 110 stereoscopic disc images, of which 40 were healthy, 48 glaucomatous, and six ocular hypertensive, with 16 duplicates images. Sensitivity, specificity and overall accuracy were calculated and compared between optometrist groups and with the EODAT ophthalmologists using permutation analysis. Results: Median sensitivity was 0.92 (95% CI: 0.70, 1.00) and median specificity was 0.74 (95% CI: 0.62, 0.88). Median overall accuracy was 80% (95% CI: 67%, 88%). Agreement between optometrists was moderate (Fleiss' κ: 0.57). Optometrists with higher qualifications did not have overall higher sensitivity than those without (p = 0.23), but had higher specificity (p = 0.001) and higher overall accuracy (p < 0.001). Optometrists displayed higher sensitivity but lower specificity than the EODAT ophthalmologists. Conclusion: UK optometrists displayed a high sensitivity and moderate specificity when assessing optic discs for the presence of glaucoma, in the context of this study

Measuring Reciprocity in High Functioning Children and Adolescents with Autism Spectrum Disorders

Few instruments have been developed that measure impairments in reciprocity, a defining feature of autism. We introduce a new test assessing the quality of reciprocal behaviour: the interactive drawing test (IDT). Children and adolescents (n = 49) with and without high functioning autism spectrum disorders (HFASD) were invited to collaborate with an experimenter in making a joint drawing. Within both groups the performance on collaborative reciprocity improved with age. However, compared to the control group, HFASD participants showed less collaborative and more basic reciprocal behaviour and preferred to draw their own objects. They were less tolerant of the experimenter’s input as well. Performance on the IDT was independent of estimated verbal IQ. Reciprocal behaviour in self-initiated objects corresponded with more parental reported autistic traits, while reciprocal behaviour in other-initiated objects corresponded with less autistic traits. The findings of this study suggest that IDT is a promising instrument to assess reciprocity

Shared cognition in childhood anxiety: interpretation bias in preschool children and their parents

Although interpretation bias has been associated with the development and/or maintenance of childhood anxiety, its origins remain unclear. The present study is the first to examine intergenerational transmission of this bias from parents to their preschool-aged children via the verbal information pathway. A community sample of fifty parent–child pairs was recruited. Parents completed measures of their own trait anxiety and interpretation bias, their child’s anxiety symptoms, and a written story-stem measure, to capture the way parents tell their children stories. Interpretation bias was assessed in preschool-aged children (aged between 2 years 7 months and 5 years 8 months) using an extended story-stem paradigm. Young children’s interpretation bias was not significantly associated with their own anxiety symptoms. Neither was there evidence for a significant association between parent and child interpretation bias. However, parents who reported they would tell their child one or more threatening story endings in the written story-stem task had significantly higher anxiety than those who did not include any threatening story endings. In turn, children whose parents did not include any threatening endings in their written stories had significantly lower threat interpretations on the child story-stem paradigm, compared to those with parents who included at least one threatening story ending. The results suggest that parental verbal information could play a role in the development of interpretation bias in young children