Re: Recognition and management of psychosis and schizophrenia in children and young people : summary of NICE guidance.

The publication of NICE guidelines relating to the Recognition and management of Psychosis and Schizophrenia in children and young people 1 is to be welcomed given the lack of published guidance in this area, especially concerning the management of young people deemed to be at high risk of psychosis 2,3. However, we feel that the working group may have missed an opportunity to incorporate the views of current adolescent service users. The guideline development process included service-user representation at all stages. However, there was a dearth of published literature in relation to the experiences and treatment preferences of child and adolescent service users with psychosis to draw on 4 although we note the guidelines did not reference our recently published study in this area 5. Indeed, this is a patient group rarely consulted, possibly due to a perception that young people may find it difficult to articulate hallucinatory experiences or have inaccurate recall of events 6,7. However, there is a growing acceptance that eliciting and learning from service users' views is an important means of improving the quality of future health care and research within the NHS 8,9. Indeed, where the evidence base is uncertain, as in the present case, patient preferences may play a more significant role in treatment selection 10. In response to our concerns we are working with our local Early Intervention in Psychosis service to address this issue by offering information to young people describing possible therapeutic options and asking them to state their preferences

Mobile games with intelligence: a killer application?

Mobile gaming is an arena full of innovation, with developers exploring new kinds of games, with new kinds of interaction between the mobile device, players, and the connected world that they live in and move through. The mobile gaming world is a perfect playground for AI and CI, generating a maelstrom of data for games that use adaptation, learning and smart content creation. In this paper, we explore this potential killer application for mobile intelligence. We propose combining small, light-weight AI/CI libraries with AI/CI services in the cloud for the heavy lifting. To make our ideas more concrete, we describe a new mobile game that we built that shows how this can work

Lateral Variation in Crustal Structure along the Lesser Antilles Arc from Petrology of Crustal Xenoliths and Seismic Receiver Functions

We reconstruct crustal structure along the Lesser Antilles island arc using an inversion approach combining constraints from petrology of magmatic crustal xenoliths and seismic receiver functions. Xenoliths show considerable island-to-island variation in xenolith petrology from plagioclase-free ultramafic lithologies to gabbros and gabbronorites with variable proportions of amphibole, indicative of changing magma differentiation depths. Xenoliths represent predominantly cumulate compositions with equilibration depths in the range 5 to 40 km. We use xenolith mineral modes and compositions to calculate seismic velocities () and density at the estimated equilibration depths. We create a five-layer model of crustal structure for testing against receiver functions (RF) from island seismic stations along the arc. Lowermost layer (5) comprises peridotite with physical characteristics of mantle xenoliths from Grenada. Uppermost layer (1) consists of 5 km of volcaniclastics and sediments, whose physical properties are determined via a grid inversion routine. The three middle layers (2) to (4) comprise igneous arc crust with compositions corresponding to the xenoliths sampled at each island. By inversion we obtain a petrological best-fit for the RF on each island to establish the nature and thicknesses of layers (2) to (4). Along the arc we see variations in the depth and strength of both Moho and mid-crustal discontinuity (MCD) on length-scales of tens of km. Moho depths vary from 25 to 37 km; MCD from 11 and 32 km. The Moho is the dominant discontinuity beneath some islands (St. Kitts, Guadeloupe, Martinique, Grenada), whereas the MCD dominates beneath others (Saba, St. Eustatius). Along-arc variability in MCD depth and strength is consistent with variation in estimated magmatic H2O contents and differentiations depths that, in turn, influence xenolith lithologies. A striking feature is steep, along-arc gradients in similar to those observed at other oceanic arcs. These gradients reflect abrupt changes in rates and processes of magma generation in the underlying crust and mantle. We find no evidence for large, interconnected bodies of partial melt beneath the Lesser Antilles. Instead, the crustal velocity structure is consistent with magma differentiation in vertically-extensive, crystal mush-dominated reservoirs. Along-arc variation in crustal structure may reflect heterogeneous upwelling within the mantle wedge, itself driven by variation in slab-derived H2O fluxes.This work was supported by Natural Environment Research Council grants NE/N001966/1, NE/K004883/1, NE/K014978/1 and NE/K010824/1 and ERC Advanced Grant CRITMAG (Blundy

Rapides établissement et examen effectués en collaboration des compétences requises dans les programmes de résidence en médecine familiale durant la pandémie de la COVID-19

Background: In March 2020, the COVID-19 pandemic disrupted competency-based medical education in Family Medicine programs across Canada. Faculty and residents identified a need for clear, relevant, and specific competencies to frame teaching, learning, supervision and feedback during the pandemic. Methods: A rapid, iterative, educational quality improvement process was launched. Phase 1 involved experienced educators defining gaps in our program’s existing competency-database, reviewing emerging public health and regulatory guidelines, and drafting competencies. Phase 2 involved translation, member-checking, and anonymous feedback and editing of draft competencies by residents and other educational leaders. Phase 3 involved wider dissemination, collaborative editing and feedback from residents and faculty throughout the department. Results: A total of 44 physicians including residents and faculty from multiple contexts provided detailed feedback, review, and editing of an ultimate list of 33 competencies organized by CanMEDS-FM roles. Broad agreement was obtained that the competencies form reasonable learning outcomes during the COVID-19 pandemic. Conclusions: These competencies represent learning objectives reflecting the initial educational mindsets of a wide range of teachers and learners experiencing a global pandemic. The project illustrates a novel collaboration across educational portfolios as a rapid educational response to a public health crisis

Gearing to success with national breastfeeding programmes: The Becoming Breastfeeding Friendly (BBF) initiative experience

Evidence-based policy toolboxes are essential for decision makers to effectively invest in and scale up maternal-child health and nutrition programs, and breastfeeding is no exception. This special issue focuses on the experiences implementing the Becoming Breastfeeding Friendly (BBF) toolbox in England, Scotland, and Wales. BBF is an initiative that includes a toolbox for decision making based on the Complex Adaptive System-based Breastfeeding Gear Model. The BBF initiative experience in Great Britain presented in this special issue illustrates how versatile BBF is as it can be readily adapted to the specific application context. In this instance one country, England was trained by the Yale School of Public Health team that developed BBF. England, in turn, trained and assisted Scotland and Wales with the implementation and oversight of BBF in those countries. The positive experience implementing BBF in Great Britain is fully consistent with findings related to this initiative in other countries with contrasting economic, social, political and health care systems; including Germany, Ghana, Mexico, Myanmar, and Samoa. In all instances BBF has led to breastfeeding policy improvements with strong implications for enabling breastfeeding environments including maternity benefits, workforce development, the Baby Friendly Hospital Initiative and behavior change communication campaigns. In conclusion, BBF is a powerful tool to help guide the effective scaling up of evidence-based programmes to advance breastfeeding protection, promotion and support globally

General Video Game Playing

One of the grand challenges of AI is to create general intelligence: an agent that can excel at many tasks, not just one. In the area of games, this has given rise to the challenge of General Game Playing (GGP). In GGP, the game (typically a turn-taking board game) is defined declaratively in terms of the logic of the game (what happens when a move is made, how the scoring system works, how the winner is declared, and so on). The AI player then has to work out how to play the game and how to win. In this work, we seek to extend the idea of General Game Playing into the realm of video games, thus forming the area of General Video Game Playing (GVGP). In GVGP, computational agents will be asked to play video games that they have not seen before. At the minimum, the agent will be given the current state of the world and told what actions are applicable. Every game tick the agent will have to decide on its action, and the state will be updated, taking into account the actions of the other agents in the game and the game physics. We envisage running a competition based on GVGP playing, using arcadestyle (e.g. similar to Atari 2600) games as our starting point. These games are rich enough to be a formidable challenge to a GVGP agent, without introducing unnecessary complexity. The competition that we envisage could have a number of tracks, based on the form of the state (frame buffer or object model) and whether or not a forward model of action execution is available. We propose that the existing Physical Travelling Salesman (PTSP) software could be extended for our purposes and that a variety of GVGP games could be created in this framework by AI and Games students and other developers. Beyond this, we envisage the development of a Video Game Description Language (VGDL) as a way of concisely specifying video games. For the competition, we see this as being an interesting challenge in terms of deliberative search, machine learning and transfer of existing knowledge into new domains