Aberrant Salience and Probabilistic Reasoning in Distressing Attenuated Positive Psychotic Symptoms: An Examination of a Two Factor Model

Theoretical psychological models of positive psychotic symptoms have increasingly emphasized the interaction of multiple cognitive factors. Research into delusions in particular has focused on the interaction of two factors; a perceptual anomaly that gives rise to a need for explanation, and a bias toward premature acceptance of a hypothesis. Recently this two factor approach has been applied to positive psychotic symptoms more broadly. Two candidate factors have received extensive theoretical and empirical interest. The aberrant salience hypothesis posits that salience regulation, mediated by dopamine, goes awry in psychosis, giving rise to a generalized sense of undue significance that is applied to neutral perceptual stimuli. For the person who experiences it, this unwarranted sense of significance seems to demand an explanation. A second candidate factor, the jumping to conclusions bias has come to be regarded as one of the most stable findings in psychosis research. Reliably associated with the presence of delusions, but also associated with positive symptoms more broadly, the bias is seen when psychotic participants make a probabilistic decision on the basis of less evidence than controls. These factors may work in concert to establish unrealistic conclusions about the nature of perceptual inputs, giving rise to psychotic explanations. In a quasi-experimental study, individuals who endorsed an unusually high level of distressing attenuated positive psychotic symptoms (DAPPS) were compared with controls who endorse a lower than average number. Participants completed one behavioral and one self-report measure of aberrant salience, and a commonly used task for assessing the presence of bias in probabilistic reasoning. Results: Preliminary analyses revealed that participants in the current study did not respond in the expected way to the behavioral measure of aberrant salience. It is possible that the task used is insufficiently sensitive to detect subtle variations in salience processing among non-clinical individuals. In terms of the main results, multiple independent samples t-tests (corrected for multiple comparisons) revealed a group difference only on the self-report measure of aberrant salience. Groups showed no significant difference on the test of probabilistic reasoning, though the group with elevated rates of DAPPS requested more evidence than controls. Logistic regression models predicting group membership from the experimental variables suggested that while the inclusion of aberrant salience significantly improved predictive accuracy, neither probabilistic reasoning nor the interaction between aberrant salience and probabilistic reasoning increased predictive accuracy. This result is a consistent with an interpretation on which distressing attenuated positive psychotic symptoms are associated with aberrant salience attribution but not with probabilistic reasoning deficits. Further research is needed to establish whether these variables interact in clinical samples

Organic Farming in Wales 2003 - 2004

Organic Centre Wales (OCW) was originally formed to act as an information source for producers enquiring into organic farming; in our second phase, in response to changes in the sector, we have an increased remit on policy issues. It has been a busy time, seeing the production of a second Organic Action Plan, the implementation of the CAP reform and development work on agri-environment reforms. The year also saw the start of organic maintenance payments for farmers. This Annual Report contains accounts of the progress that has been made on many fronts during the last 12 months, particularly in market knowledge due to the research for the recently published report, 'Organic Food: understanding the consumer and increasing sales'. This information, together with continuing product development work, will enable Welsh organic producers to be proactive in building a solid consumer base

Comparing Water Level Estimation in Coastal and Shelf Seas From Satellite Altimetry and Numerical Models

Accurately resolving coastal Total Water Levels (TWL) is crucial for socio-economic and environmental reasons. Recent efforts in satellite altimetry and numerical modelling have improved accuracy over near-shore areas. In this study we used data from tide gauges (TGs), SAR-mode altimetry from two satellites (Sentinel-3A (S3) and CryoSat-2 (C2)), and a state-of-the-art high-resolution regional coupled environmental prediction model (Amm15) to undertake an inter-comparison between the observations and the model. The aim is to quantify our capability to measure TWL around the UK coast, and to quantify the capacity of the model to represent coastal TWL. Results show good agreement between the satellite and TG data (the mean correlation (R) over seventeen TGs between June 2016 and September 2017 is 0.85 for S3 and 0.80 for C2). The satellite-model comparison shows that the variability is well captured (R=0.98 for both satellite), however there is an offset (-0.23m for S3, -0.15m for C2) between the satellite and model data, that is near-constant across the domain. This offset is partly attributed to the difference in the reference level used by the satellites and the model, and residual differences linked to the temporal resolution of the model. The best agreement between model and satellite is seen away from the coast, further than 3-4km offshore. However, even within the coastal band, R remains high, ~0.95 (S3) and ~0.96 (C2). In conclusion, models are still essential to represent TWL in coastal regions where there is no cover from in-situ observations, but satellite altimeters can now provide valuable observations that are reliable much closer to the coast than before

Determination of thyroid volume in infants with suspected congenital hypothyroidism—the limitations of both subjective and objective evaluation

Objective: To compare two methods of assessing gland size on thyroid ultrasound in newborn infants with suspected congenital hypothyroidism (CH). Methods: Images from infants with eutopic glands referred between 2007 and 2013 were evaluated blind by two sets of observers. Subjective gland size was categorised as small, borderline-small, normal, borderline-large and large. Objective gland volume, calculated as the sum of each lobe using the prolate ellipsoid formula (length x width x depth x π/6), was put into corresponding categories: <0.8, 0.81–1.0, 1.1– <2.2, 2.2–2.4 and >2.4 ml, derived from normative Scottish data. Results: Of 36 infants, permanent CH was present in 17, transient CH in 17, status uncertain in 2. Mean (SD) intraobserver error for thyroid volume measurement was 0.11 (0.23) ml [8.3%]. Subjective assessment by two observers was discordant in only four (10.8%) infants. However, subjective vs objective evaluation was discordant in 14 (39%). Eight (three permanent, five transient CH) had large glands subjectively but normal glands objectively; and six (four transient CH) had normal glands subjectively but small glands objectively. The former infants all showed a single flattened curve to the anterior thyroid margin, giving an impression of bulkiness. Gland shape was normal in the latter infants. Conclusion: Neither subjective nor objective evaluation predicts permanent vs transient CH. Altered gland shape may confound both methods, and undermine use of the conventional formula for measuring lobe volume. Advances in knowledge: Until more refined methods are available for assessing thyroid size, both subjective and objective evaluation are recommended in CH

Increasing the capacity of policy agencies to use research findings : a stepped-wedge trial

SPIRIT was funded as part of the Centre for Informing Policy in Health with Evidence from Research (CIPHER), an Australian National Health and Medical Research Council (NHMRC) Centre for Research Excellence (APP1001436), which is administered by the Sax Institute. CIPHER is a joint project of the Sax Institute; Australasian Cochrane Centre, Monash University; University of Newcastle; University of New South Wales; Research Unit for Research Utilisation, University of St Andrews; Australian National University; and University of South Australia.Background:  This paper describes the trial of a novel intervention, Supporting Policy In health with evidence from Research: an Intervention Trial (SPIRIT). It examines (1) the feasibility of delivering this kind of programme in practice; (2) its acceptability to participants; (3) the impact of the programme on the capacity of policy agencies to engage with research; and (4) the engagement with and use of research by policy agencies. Methods:  SPIRIT was a multifaceted, highly tailored, stepped-wedge, cluster-randomised, trial involving six health policy agencies in Sydney, Australia. Agencies were randomly allocated to one of three start dates to receive the 1-year intervention programme. SPIRIT included audit, feedback and goal setting; a leadership programme; staff training; the opportunity to test systems to facilitate research use in policies; and exchange with researchers. Outcome measures were collected at each agency every 6 months for 30 months. Results:  Participation in SPIRIT was associated with significant increases in research use capacity at staff and agency levels. Staff reported increased confidence in research use skills, and agency leaders reported more extensive systems and structures in place to support research use. Self-report data suggested there was also an increase in tactical research use among agency staff. Given the relatively small numbers of participating agencies and the complexity of their contexts, findings suggest it is possible to effect change in the way policy agencies approach the use of research. This is supported by the responses on the other trial measures; while these were not statistically significant, on 18 of the 20 different measures used, the changes observed were consistent with the hypothesised intervention effect (that is, positive impacts). Conclusions:  As an early test of an innovative approach, SPIRIT has demonstrated that it is possible to increase research engagement and use in policy agencies. While more work is needed to establish the replicability and generalisability of these findings, this trial suggests that building staff skills and organisational structures may be effective in increasing evidence use.Publisher PDFPeer reviewe

Evaluating the effectiveness and reliability of the Vibrant Soundbridge and Bonebridge auditory implants in clinical practice: Study design and methods for a multi-centre longitudinal observational study.

BACKGROUND: The Vibrant Soundbridge middle ear implant and the Bonebridge bone conducting hearing device are hearing implants that use radio frequency transmission to send information from the sound processor to the internal transducer. This reduces the risk of skin problems and infection but requires a more involved surgical procedure than competitor skin penetrating devices. It is not known whether more complex surgery will lead to additional complications. There is little information available on the reliability of these systems and adverse medical or surgical events. The primary research question is to determine the reliability and complication rate for the Vibrant Soundbridge and Bonebridge. The secondary research question explores changes in quality of life following implantation of the devices. The tertiary research question looks at effectiveness via changes in auditory performance. METHOD: The study was designed based on a combination of a literature search, two clinician focus groups and expert review.A multi-centre longitudinal observational study was designed. There are three study groups, two will have been implanted prior to the start of the study and one group, the prospective group, will be implanted after initiation of the study. Outcomes are surgical questionnaires, measures of quality of life, user satisfaction and speech perception tests in quiet and in noise. CONCLUSION: This is the first multi-centre study to look at these interventions and includes follow up over time to understand effectiveness, reliability, quality of life and complications

Pediatric immunization-related safety incidents in primary care: A mixed methods analysis of a national database.

Background: Children are scheduled to receive 18–20 immunizations before their 18th birthday in England and Wales; this approximates to 13 million vaccines administered per annum. Each immunization represents a potential opportunity for immunization-related error and effective immunization is imperative to maintain the public health benefit from immunization. Using data from a national reporting system, this study aimed to characterize pediatric immunization-related safety incident reports from primary care in England and Wales between 2002 and 2013. Methods: A cross-sectional mixed methods study was undertaken. This comprised reading the free-text of incident reports and applying codes to describe incident type, potential contributory factors, harm severity, and incident outcomes. A subsequent thematic analysis was undertaken to interpret the most commonly occurring codes, such as those describing the incident, events leading up to it and reported contributory factors, within the contexts they were described. Results: We identified 1745 reports and most (n = 1077, 61.7%) described harm outcomes including three deaths, 67 reports of moderate harm and 1007 reports of low harm. Failure of timely vaccination was the potential cause of three child deaths from meningitis and pneumonia, and described in a further 113 reports. Vaccine administration incidents included the wrong number of doses (n = 476, 27.3%), wrong timing (n = 294, 16.8%), and wrong vaccine (n = 249, 14.3%). Documentation failures were frequently implicated. Socially and medically vulnerable children were commonly described. Conclusion: This is the largest examination of reported contributory factors for immunization-related patient safety incidents in children. Our findings suggest investments in IT infrastructure to support data linkage and identification of risk predictors, development of consultation models that promote the role of parents in mitigating safety incidents, and improvement efforts to adapt and adopt best practices from elsewhere, are needed to mitigate future immunization-related patient safety incidents. These priorities are particularly pressing for vulnerable patient groups.8 page(s