Modelling health state preference data using a non-parametric Bayesian method

This paper reports on the findings from the application of a recently reported approach to modelling health state valuation data. The approach applies a nonparametric model to estimate the revised version of the Health Utilities Index Mark 2 (HUI 2) health state valuation algorithm using Bayesian methods. The data set is the UK HUI 2 valuation study where a sample of 51 states defined by the HUI 2 was valued by a sample of the UK general population using standard gamble. The paper presents the results from applying the nonparametric model and compares these to the original model estimated using a conventional parametric random effects model. The two models are compared in terms of their predictive performance. The paper discusses the implications of these results for future applications of the HUI 2 and further work in this field

Non-verbal communication in meetings of psychiatrists and patients with schizophrenia

Objective Recent evidence found that patients with schizophrenia display non‐verbal behaviour designed to avoid social engagement during the opening moments of their meetings with psychiatrists. This study aimed to replicate, and build on, this finding, assessing the non‐verbal behaviour of patients and psychiatrists during meetings, exploring changes over time and its association with patients' symptoms and the quality of the therapeutic relationship. Method 40‐videotaped routine out‐patient consultations, involving patients with schizophrenia, were analysed. Non‐verbal behaviour of patients and psychiatrists was assessed during three fixed, 2‐min intervals using a modified Ethological Coding System for Interviews. Symptoms, satisfaction with communication and the quality of the therapeutic relationship were also measured. Results Over time, patients' non‐verbal behaviour remained stable, whilst psychiatrists' flight behaviour decreased. Patients formed two groups based on their non‐verbal profiles, one group (n = 25) displaying pro‐social behaviour, inviting interaction and a second (n = 15) displaying flight behaviour, avoiding interaction. Psychiatrists interacting with pro‐social patients displayed more pro‐social behaviours (P < 0.001). Patients' pro‐social profile was associated reduced symptom severity (P < 0.05), greater satisfaction with communication (P < 0.001) and positive therapeutic relationships (P < 0.05). Conclusion Patients' non‐verbal behaviour during routine psychiatric consultations remains unchanged, and is linked to both their psychiatrist's non‐verbal behaviour and the quality of the therapeutic relationship

THERACOM: a systematic review of the evidence base for interventions to improve Therapeutic Communications between black and minority ethnic populations and staff in specialist mental health services.

PMCID: PMC3599664This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.BACKGROUND: Black and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction. Although many explanations have been put forward to explain this, a failure of therapeutic communications may explain poorer satisfaction, disengagement from services and ethnic variations in access to less coercive care. Interventions that improve therapeutic communications may offer new approaches to tackle ethnic inequalities in experiences and outcomes. METHODS: The THERACOM project is an HTA-funded evidence synthesis review of interventions to improve therapeutic communications between black and minority ethnic patients in contact with specialist mental health services and staff providing those services. This article sets out the protocol methods for a necessarily broad review topic, including appropriate search strategies, dilemmas for classifying different types of therapeutic communications and expectations of the types of interventions to improve them. The review methods will accommodate unexpected types of study and interventions. The findings will be reported in 2013, including a synthesis of the quantitative and grey literature. DISCUSSION: A particular methodological challenge is to identify and rate the quality of many different study types, for example, randomised controlled trials, observational quantitative studies, qualitative studies and case studies, which comprise the full range of hierarchies of evidence. We discuss the preliminary methodological challenges and some solutions. (PROSPERO registration number: CRD42011001661)

Comparative grazing behaviour of lactating suckler cows of contrasting genetic merit and genotype

peer-reviewedThe objective of this study was to determine if differences in grazing behaviour exist between lactating suckler cows diverse in genetic merit for the national Irish Replacement index and of two contrasting genotypes. Data from 103 cows: 41 high and 62 low genetic merit, 43 beef and 60 beef x dairy (BDX) cows were available over a single grazing season in 2015. Milk yield, grass dry matter intake (GDMI), cow live weight (BW) and body condition score (BCS) were recorded during the experimental period, with subsequent measures of production efficiency extrapolated. Grazing behaviour data were recorded twice in conjunction with aforementioned measures, using Institute of Grassland and Environmental Research headset behaviour recorders. The effect of genotype and cow genetic merit during mid- and late-lactation on grazing behaviour phenotypes, milk yield, BW, BCS and GDMI were estimated using linear mixed models. Genetic merit had no significant effect on any production parameters investigated, with the exception that low genetic merit had a greater BCS than high genetic merit cows. Beef cows were heavier, had a greater BCS but produced less milk per day than BDX. The BDX cows produced more milk per 100 kg BW and per unit intake and had greater GDMI, intake per bite and rate of GDMI per 100 kg BW than beef cows. High genetic merit cows spent longer grazing and took more bites per day but had a lower rate of GDMI than low genetic merit cows, with the same trend found when expressed per unit of BW. High genetic merit cows spent longer grazing than low genetic merit cows when expressed on a per unit intake basis. Absolute rumination measures were similar across cow genotype and genetic merit. When expressed per unit BW, BDX cows spent longer ruminating per day compared to beef. However, on a per unit intake basis, beef cows ruminated longer and had more mastications than BDX. Intake per bite and rate of intake was positively correlated with GDMI per 100 kg BW. The current study implies that despite large differences in grazing behaviour between cows diverse in genetic merit, few differences were apparent in terms of production efficiency variables extrapolated. Conversely, differences in absolute grazing and ruminating behaviour measurements did not exist between beef cows of contrasting genotype. However, efficiency parameters investigated illustrate that BDX will subsequently convert herbage intake more efficiently to milk production

The Web as an Adaptive Network: Coevolution of Web Behavior and Web Structure

Much is known about the complex network structure of the Web, and about behavioral dynamics on the Web. A number of studies address how behaviors on the Web are affected by different network topologies, whilst others address how the behavior of users on the Web alters network topology. These represent complementary directions of influence, but they are generally not combined within any one study. In network science, the study of the coupled interaction between topology and behavior, or state-topology coevolution, is known as 'adaptive networks', and is a rapidly developing area of research. In this paper, we review the case for considering the Web as an adaptive network and several examples of state-topology coevolution on the Web. We also review some abstract results from recent literature in adaptive networks and discuss their implications for Web Science. We conclude that adaptive networks provide a formal framework for characterizing processes acting 'on' and 'of' the Web, and offers potential for identifying general organizing principles that seem otherwise illusive in Web Scienc

How do healthcare professionals interview patients to assess suicide risk?

Background: There is little evidence on how professionals communicate to assess suicide risk. This study analysed how professionals interview patients about suicidal ideation in clinical practice. Methods: Three hundred nineteen video-recorded outpatient visits in U.K. secondary mental health care were screened. 83 exchanges about suicidal ideation were identified in 77 visits. A convenience sample of 6 cases in 46 primary care visits was also analysed. Depressive symptoms were assessed. Questions and responses were qualitatively analysed using conversation analysis. χ 2 tested whether questions were influenced by severity of depression or influenced patients’ responses. Results: A gateway closed question was always asked inviting a yes/no response. 75% of questions were negatively phrased, communicating an expectation of no suicidal ideation, e.g., “No thoughts of harming yourself?”. 25% were positively phrased, communicating an expectation of suicidal ideation, e.g., “Do you feel life is not worth living?”. Comparing these two question types, patients were significantly more likely to say they were not suicidal when the question was negatively phrased but were not more likely to say they were suicidal when positively phrased (χ 2 = 7.2, df = 1, p = 0.016). 25% patients responded with a narrative rather than a yes/no, conveying ambivalence. Here, psychiatrists tended to pursue a yes/no response. When the patient responded no to the gateway question, the psychiatrist moved on to the next topic. A similar pattern was identified in primary care. Conclusions: Psychiatrists tend to ask patients to confirm they are not suicidal using negative questions. Negatively phrased questions bias patients’ responses towards reporting no suicidal ideation

Evaluating the Impact of Biofortification: A Meta-analysis of Community-level Studies on Quality Protein Maize (QPM)

Biofortification, or the genetic improvement of the nutritional quality of food crops, is a promising strategy to combat undernutrition, particularly among the rural poor in developing countries. However, traditional methods of impact assessment do not apply to biofortified crops as little or no yield increases are expected. Significant progress has been made to develop maize varieties with improved protein quality, collectively known as quality protein maize (QPM). Evidence for the impact of QPM at the community level, as demonstrated by randomized, controlled studies, was evaluated using meta-analysis. A new and generalizable effect size was proposed to quantify the impact of QPM on a key outcome, child growth. The results indicated that consumption of QPM instead of conventional maize leads to an 8% (95% CI: 4-12%) increase in the rate of growth in height and a 9% (95% CI: 4-12%) increase in the rate of growth in weight in infants and young children with mild to moderate undernutrition from populations in which maize is a significant part of the diet. These results are the first step in evaluating the potential economic impact of QPM by establishing and quantifying a link between use of the improved crop and nutritional outcomes. QPM can serve as a model for other biofortification efforts, and in particular, the conceptual framework and methodologies for impact assessment are directly applicable to other biofortified crops.Impact assessment, biofortification, meta-analysis, Crop Production/Industries, Food Security and Poverty,

A new scale to assess the therapeutic relationship in community mental health care: STAR

Background. No instrument has been developed specifically for assessing the clinician-patient therapeutic relationship (TR) in community psychiatry. This study aimed to develop a measure of the TR with clinician and patient versions using psychometric principles for test construction. Method. A four-stage prospective study was undertaken, comprising qualitative semi-structured interviews about TRs with clinicians and patients and their assessment of nine established scales for their applicability to community care, administering an amalgamated scale of more than 100 items, followed by Principal Components Analysis (PCA) of these ratings for preliminary scale construction. test-retest reliability of the scale and administering the scale in a new sample to confirm its factorial structure. The sample consisted of patients with severe mental illness and a designated key worker in the care of 17 community mental health teams in England and Sweden. Results. New items not covered by established scales were identified, including clinician helpfulness in accessing services, patient aggression and family interference. The new patient (STAR-P) and clinician scales (STAR-C) each have 12 items comprising three subscales: positive collaboration and positive clinician input in both versions, non-supportive clinician input in the patient version, and emotional difficulties in the clinician version. Test-retest reliability was r = 0(.)76 for STAR-P and r = 0(.)68 for STAR-C. The factorial structure of the new scale was confirmed with a good fit. Conclusions. STAR is a specifically developed, brief scale to assess TRs in community psychiatry with good psychometric properties and is suitable for use in research and routine care

Friends and Symptom Dimensions in Patients with Psychosis: A Pooled Analysis

PMCID: PMC3503760This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited