Examination of the contribution of clinical and psychological factors to treatment decision-making capacity in psychosis

Purpose: A systematic review and meta-analysis was conducted to identify what factors have been investigated as correlates of the 4 key domains of treatment decision making capacity (TDMC) in people who have experienced psychosis (understanding, reasoning, appreciation, communication) and to provide estimates of the magnitude of these correlations, taking into account study quality. A novel empirical study was conducted to test the hypothesis that variance in psychosis-specific cognitive biases (including the well-established ‘jumping to conclusions’ bias) would account for unique variance in TDMC domains in those with psychosis, after taking into account the known contribution of symptoms and insight. A secondary aim of the empirical study was to examine for the first time the relationship between TDMC and personal recovery in this group, and post hoc analyses of the relationship between cognitive biases, emotional distress and TDMC were also conducted. Methods: Electronic databases were systematically searched for literature on the schizophrenia and psychosis and treatment decision making capacity. Pooled estimates of correlation were estimated for factors with data from three or more studies, and both study and outcome quality were systematically assessed. A cross-sectional observational study was conducted, and individuals with psychosis completed measures of TDMC, cognitive biases, psychotic symptoms and recovery. Multiple regression was used to examine the primary and secondary hypotheses, and mediation analyses were used to conduct the post hoc analyses. Additional data from a parallel study was incorporated to increase power. Results: Twenty-four studies met inclusion criteria for the systematic review and meta-analysis. Low to moderate quality evidence suggested that the ability of people with psychosis to understand treatment-relevant information was strongly associated with overall psychotic symptom severity, verbal cognitive functioning and years of education, but not depression (moderate quality evidence). Low quality evidence suggested reasoning was strongly associated with verbal cognitive functioning and moderately associated with symptoms. Appreciation was associated with symptoms, but it and communication were generally poorly studied. Findings from the empirical study suggest that cognitive biases, and the Jumping to Conclusions bias in particular, predicts a moderate amount of the variance in the understanding and reasoning TDMC domains, but did not add predictive power to a model containing symptoms, insight, and cognition. The appreciation domain was strongly predicted by cognitive biases, insight, and cognition. TDMC was not found to be correlated with personal recovery and post hoc analyses did not find that emotional distress mediated any relationship between cognitive biases and TDMC. Conclusions: The meta-analysis confirms there is a robust association between symptoms and TDMC in psychosis, as currently conceived. The empirical study suggests cognitive biases may be related to TDMC, even after taking into account the contribution of symptoms. Larger studies, perhaps employing experimental procedures, are required to clarify the exact nature of this relationship. The lack of any relationship between TDMC and service-user defined recovery from psychosis is notable, and lends support to those calling for a conceptualisation of TDMC that takes greater account of this concept

Stakeholder Engagement through Participatory Action Research at iSPARC

The Implementation Science & Practice-based Advances Research Center (iSPARC) is a new DMH-funded collaborative effort between the former Systems and Psychosocial Advances Research Center, Quantitative Health Sciences and Boston University\u27s Center for Psychiatric Rehabilitation. With 52 core and affiliate investigators, iSPARC features five interacting programs: Stakeholder Engagement, Public Mental Health and Implementation Research, Technical Assistance and Consultation, Workforce Development, and External Funding. The mission of the Stakeholder Engagement Program is to lead the mental health research community and beyond in working in partnership with individuals with lived mental health experience, their families, and the agencies that serve them. This program intersects with several of iSPARC\u27s activities. It includes three active advisory groups with more than 20 members representing youth, individuals with lived mental health experience, and family members. These advisory groups adopt a participatory action research (PAR) approach and seek to engage community stakeholders at every stage of research, from development through enrollment and dissemination. Starting in 2018, the Stakeholder Program will seek to increase engagement and diversity through several additional initiatives. A new community provider advisory group is currently being developed and the Program is working to assess and assure diversity across all advisory groups. The Program will use a structured assessment tool and continuous quality improvement approach to measure and facilitate participatory action research across all iSPARC\u27s projects. The Program will develop and disseminate products to assist other organizations in initiating and maintaining stakeholder engagement. The proposed poster will summarize these activities and include examples of products created

Multiple plumage traits convey information about age and within-age-class qualities of a canopy-dwelling songbird, the Cerulean Warbler

Colorful plumage traits in birds may convey multiple, redundant, or unreliable messages about an individual. Plumage may reliably convey information about disparate qualities such as age, condition, and parental ability because discrete tracts of feathers may cause individuals to incur different intrinsic or extrinsic costs. Few studies have examined the information content of plumage in a species that inhabits forest canopies, a habitat with unique light environments and selective pressures. We investigated the information content of four plumage patches (blue-green crown and rump, tail white, and black breast band) in a canopy-dwelling species, the Cerulean Warbler (Setophaga cerulea), in relation to age, condition, provisioning, and reproduction. We found that older males displayed wider breast bands, greater tail white, and crown and rump feathers with greater blue-green (435–534 nm) chroma and hue than males in their first potential breeding season. In turn, older birds were in better condition (short and long term) and were reproductively superior to younger birds. We propose that these age-related plumage differences (i.e. delayed plumage maturation) were not a consequence of a life history strategy but instead resulted from constraints during early feather molts. Within age classes, we found evidence to support the multiple messages hypothesis. Birds with greater tail white molted tails in faster, those with more exaggerated rump plumage (lower hue, greater blue-green chroma) provisioned more, and those with lower rump blue-green chroma were in better condition. Despite evidence of reliable signaling in this species, we found no strong relationships between plumage and reproductive performance, potentially because factors other than individual differences more strongly influenced fecundity

Distance models as a tool for modelling detection probability and density of native bumblebees

Effective monitoring of native bee populations requires accurate estimates of population size and relative abundance among habitats. Current bee survey methods, such as netting or pan trapping, may be adequate for a variety of study objectives but are limited by a failure to account for imperfect detection. Biases due to imperfect detection could result in inaccurate abundance estimates or erroneous insights about the response of bees to different environments. To gauge the potential biases of currently employed survey methods, we compared abundance estimates of bumblebees (Bombus spp.) derived from hierarchical distance sampling models (HDS) to bumblebee counts collected from fixed‐area net surveys (“net counts”) and fixed‐width transect counts (“transect counts”) at 47 early‐successional forest patches in Pennsylvania. Our HDS models indicated that detection probabilities of Bombus spp. were imperfect and varied with survey‐ and site‐covariates. Despite being conspicuous, Bombus spp. were not reliably detected beyond 5 m. Habitat associations of Bombus spp. density were similar across methods, but the strength of association with shrub cover differed between HDS and net counts. Additionally, net counts suggested sites with more grass hosted higher Bombus spp. densities whereas HDS suggested that grass cover was associated with higher detection probability but not Bombus spp. density. Density estimates generated from net counts and transect counts were 80%–89% lower than estimates generated from distance sampling. Our findings suggest that distance modelling provides a reliable method to assess Bombus spp. density and habitat associations, while accounting for imperfect detection caused by distance from observer, vegetation structure, and survey covariates. However, detection/ non‐detection data collected via point‐counts, line‐transects and distance sampling for Bombus spp. are unlikely to yield species‐specific density estimates unless individuals can be identified by sight, without capture. Our results will be useful for informing the design of monitoring programs for Bombus spp. and other pollinators

Impact of shortened crop rotation of oilseed rape on soil and rhizosphere microbial diversity in relation to yield decline

Oilseed rape (OSR) grown in monoculture shows a decline in yield relative to virgin OSR of up to 25%, but the mechanisms responsible are unknown. A long term field experiment of OSR grown in a range of rotations with wheat was used to determine whether shifts in fungal and bacterial populations of the rhizosphere and bulk soil were associated with the development of OSR yield decline. The communities of fungi and bacteria in the rhizosphere and bulk soil from the field experiment were profiled using terminal restriction fragment length polymorphism (TRFLP) and sequencing of cloned internal transcribed spacer regions and 16S rRNA genes, respectively. OSR cropping frequency had no effect on rhizosphere bacterial communities. However, the rhizosphere fungal communities from continuously grown OSR were significantly different to those from other rotations. This was due primarily to an increase in abundance of two fungi which showed 100% and 95% DNA identity to the plant pathogens Olpidium brassicae and Pyrenochaeta lycopersici, respectively. Real-time PCR confirmed that there was significantly more of these fungi in the continuously grown OSR than the other rotations. These two fungi were isolated from the field and used to inoculate OSR and Brassica oleracea grown under controlled conditions in a glasshouse to determine their effect on yield. At high doses, Olpidium brassicae reduced top growth and root biomass in seedlings and reduced branching and subsequent pod and seed production. Pyrenochaeta sp. formed lesions on the roots of seedlings, and at high doses delayed flowering and had a negative impact on seed quantity and quality

Spatial variation in breeding habitat selection by Cerulean Warblers (Setophaga cerulea) throughout the appalachian mountains

Studies of habitat selection are often of limited utility because they focus on small geographic areas, fail to examine behavior at multiple scales, or lack an assessment of the fitness consequences of habitat decisions. These limitations can hamper the identification of successful site-specific management strategies, which are urgently needed for severely declining species like Cerulean Warblers (Setophaga cerulea). We assessed how breeding habitat decisions made by Cerulean Warblers at multiple scales, and the subsequent effects of these decisions on nest survival, varied across the Appalachian Mountains. Selection for structural habitat features varied substantially among areas, particularly at the territory scale. Males within the least-forested landscapes selected microhabitat features that reflected more closed-canopy forest conditions, whereas males in highly forested landscapes favored features associated with canopy disturbance. Selection of nest-patch and nest-site attributes by females was more consistent across areas, with females selecting for increased tree size and understory cover and decreased basal area and midstory cover. Floristic preferences were similar across study areas: White Oak (Quercus alba), Cucumber-tree (Magnolia acuminata), and Sugar Maple (Acer saccharum) were preferred as nest trees, whereas red oak species (subgenus Erythrobalanus) and Red Maple (A. rubrum) were avoided. The habitat features that were related to nest survival also varied among study areas, and preferred features were negatively associated with nest survival at one area. Thus, our results indicate that large-scale spatial heterogeneity may influence local habitat-selection behavior and that it may be necessary to articulate site-specific management strategies for Cerulean Warblers

The effect of reducing the 'jumping to conclusions' bias on treatment decision-making capacity in psychosis: A randomised controlled trial with mediation analysis

BackgroundEvidence-based psychological interventions to support treatment decision-making capacity (‘capacity’) in psychosis do not currently exist. This study sought to establish whether reducing the extent to which this group form conclusions based on limited evidence, alsoknown as the ‘jumping to conclusions’ (JTC) bias, could improve capacity.MethodsIn a randomised-controlled open trial, 37 patients aged 16-65 years diagnosed with schizophrenia-spectrum disorders were randomly assigned (1:1) to receive a single-session intervention designed to reduce the JTC bias (MCT-JTC; adapted from MetacognitiveTraining) or an attention control (AC) condition designed to control for therapist attention, duration, modality and face validity. Primary outcomes were treatment decision-making capacity measured by the MacArthur Competency Assessment Tool for Treatment (MacCATT)and the jumping-to-conclusions reasoning bias measured by draws to decision on the Beads task, each of which were administered by the psychologist delivering the intervention.ResultsThose receiving MCT-JTC had large improvements in overall capacity (d=0.96,

Experiences of a digital health intervention for young people exposed to technology assisted sexual abuse:A qualitative study

BACKGROUND: There is growing evidence that Technology Assisted Sexual Abuse (TASA) represents a serious problem for large numbers of children. To date, there are very few evidence-based interventions available to young people (YP) after they have been exposed to this form of abuse, and access to support services remains a challenge. Digital tools such as smartphones have the potential to increase access to mental health support and may provide an opportunity for YP to both manage their distress and reduce the possibility of further victimization. The current study explores the acceptability of a digital health intervention (DHI; the i-Minds app) which is a theory-driven, co-produced, mentalization-based DHI designed for YP aged 12-18 who have experienced TASA.METHODS: Semi-structured interviews were conducted with 15 YP recruited through Child and Adolescent Mental Health Services, a Sexual Assault Referral Centre and an e-therapy provider who had access to the i-Minds app as part of a feasibility clinical trial. Interviews focused on the acceptability and usability of i-Minds and were coded to themes based on the Acceptability of Healthcare Interventions framework.RESULTS: All participants found the i-Minds app acceptable. Many aspects of the app were seen as enjoyable and useful in helping YP understand their abuse, manage feelings, and change behavior. The app was seen as usable and easy to navigate, but for some participants the level of text was problematic and aspects of the content was, at times, emotionally distressing at times.CONCLUSIONS: The i-Minds app is useful in the management of TASA and helping change some risk-related vulnerabilities. The app was designed, developed and evaluated with YP who had experienced TASA and this may account for the high levels of acceptability seen.TRIAL REGISTRATION: The trial was registered on the ISRCTN registry on the 12/04/2022 as i-Minds: a digital intervention for young people exposed to online sexual abuse (ISRCTN43130832).</p

Breeding season concerns and response to forest management: can forest management produce more breeding birds?.

Cerulean Warblers (Setophaga cerulea), one of the fastest declining avian species in North America, are associated with heterogeneous canopies in mature hardwood forests. However, the age of most second and third-growth forests in eastern North American is not sufficient for natural tree mortality to maintain structurally diverse canopies. Previous research suggests that forest management through timber harvest also may create conditions suitable as Cerulean Warbler breeding habitat. We conducted a multistate study that examined Cerulean Warbler response to varying degrees of canopy disturbance created by operational timber harvest. Specifically, 3 harvest treatments and an un-harvested reference plot were replicated on 7 study areas in 4 Appalachian states in 2005-2010. We compared pre-harvest and four years post-harvest demographic response of Cerulean Warblers. Over all study areas, Cerulean Warbler territory density remained stable in un-harvested reference plots and increased significantly the first year post-harvest on intermediate harvest plots. By year 3 post-harvest, territory density remained significantly greater for intermediate harvest than reference plots, and marginally greater for light and heavy harvests than reference plots. However, un-harvested reference plots had greater nest survival than most harvest treatments. The one exception was nest survival between reference plots and the intermediate harvest on the northern study areas did not differ. Our results indicate that intermediate harvests likely benefit Cerulean Warblers in some portions of the species’ breeding range. However, additional research is needed to better examine fitness consequences of timber harvests and to estimate population-level implications. In particular, does the greater number of nesting individuals, particularly in intermediate harvests, compensate for lower nesting success? Until researchers provide such insight, we recommend management decisions be based on local conditions, particularly in forests where Cerulean Warbler populations are high