Perception, expectation and uncertainty in autism

This thesis uses behavioural measures and self-report questionnaires to understand how autistic individuals extract predictive information from their environment, how this predictive information influences perception in autism and how these processes are associated with other clinical features of autism. In chapters 1 & 2, I start the thesis by reviewing the literature on perception, sensory issues, anxiety and learning in autism before moving on to introduce Bayesian models of perception in autism. In chapters 3, 4 & 5, I present an interrupted search paradigm and demonstrate that autistic individuals did not significantly differ from non-autistic controls in the extent to which prior information guides attention during visual search. These chapters provide a clear case of one aspect of perception in which prior information is used by autistic and non-autistic individuals in a similar manner. In chapter 6, I present a serial reaction time task which tests whether autistic individuals are able to update predictive information flexibly. The results found that autistic individuals, relative to controls, showed an overall reduction in the extent to which they utilised prior information during the task, but this was not specific to conditions in which they were required to update information about the underlying statistical regularities in the task. In chapter 7, I use a visual statistical learning task to assess how well participants were able to implicitly acquire high-level predictive statistical information. The results suggest that autistic individuals show a slightly reduced effect of learning when compared to non-autistic controls, but this effect is not specific to high-level information. In chapter 8, 9 & 10, I present a number of different questionnaire measures for which differences are found between autistic and non-autistic individuals. I used these measures to evaluate the construct of ‘intolerance of uncertainty’ and how it relates to other features of autism before moving on to show that ‘intolerance of uncertainty’ plays a mediating role in clinical features associated with autism, such as anxiety and sensory issues

Retaining the general practitioner workforce in England : what matters to GPs? A cross-sectional study

Background: The general practice (GP) workforce in England is in crisis, reflected in increasing rates of early retirement and intentions to reduce hours of working. This study aimed to investigate underlying factors and how these might be mitigated. Methods: GPs in central England were invited to participate in an on-line survey exploring career plans and views and experiences of work-related pressures. Quantitative data were analysed using logistic regression analysis and principal components analysis. Qualitative data were analysed using a thematic framework approach. Results: Of 1,192 GPs who participated, 978 (82.0 %) stated that they intend to leave general practice, take a career break and/or reduce clinical hours of work within the next five years. This included 488 (41.9 %) who intend to leave practice, and almost a quarter (279; 23.2 %) intending to take a career break. Only 67 (5.6 %) planned to increase their hours of clinical work. For participants planning to leave practice, the issues that most influenced intentions were volume and intensity of workload, time spent on “unimportant tasks”, introduction of seven-day working and lack of job satisfaction. Four hundred fifty five participants responded to open questions (39128 words in total). The main themes were the cumulative impact of work-related pressures, the changing and growing nature of the workload, and the consequent stress. Reducing workload intensity, workload volume, administrative activities, with increased time for patient care, no out-of-hour commitments, more flexible working conditions and greater clinical autonomy were identified as the most important requirements to address the workforce crisis. In addition, incentive payments, increased pay and protected time for education and training were also rated as important. Conclusions: New models of professionalism and organisational arrangements may be needed to address the issues described here. Without urgent action, the GP workforce crisis in England seems set to worsen

Enabling scalable clinical interpretation of ML-based phenotypes using real world data

The availability of large and deep electronic healthcare records (EHR) datasets has the potential to enable a better understanding of real-world patient journeys, and to identify novel subgroups of patients. ML-based aggregation of EHR data is mostly tool-driven, i.e., building on available or newly developed methods. However, these methods, their input requirements, and, importantly, resulting output are frequently difficult to interpret, especially without in-depth data science or statistical training. This endangers the final step of analysis where an actionable and clinically meaningful interpretation is needed.This study investigates approaches to perform patient stratification analysis at scale using large EHR datasets and multiple clustering methods for clinical research. We have developed several tools to facilitate the clinical evaluation and interpretation of unsupervised patient stratification results, namely pattern screening, meta clustering, surrogate modeling, and curation. These tools can be used at different stages within the analysis. As compared to a standard analysis approach, we demonstrate the ability to condense results and optimize analysis time. In the case of meta clustering, we demonstrate that the number of patient clusters can be reduced from 72 to 3 in one example. In another stratification result, by using surrogate models, we could quickly identify that heart failure patients were stratified if blood sodium measurements were available. As this is a routine measurement performed for all patients with heart failure, this indicated a data bias. By using further cohort and feature curation, these patients and other irrelevant features could be removed to increase the clinical meaningfulness. These examples show the effectiveness of the proposed methods and we hope to encourage further research in this field.Comment: 27 pages, 14 figure

Gradients of cortical hierarchy in Autism

Autism is a developmental condition associated with altered functional connectivity. We propose to re-frame the functional connectivity alterations in terms of gradients that capture the functional hierarchy of cortical processing from sensory to default-mode network regions. We hypothesized that this hierarchy will be altered in ASD. To test that, we compared the scale of gradients in people with autism and healthy controls. The present results do not support our hypothesis. There are two alternative implications: either the processing hierarchies are preserved in autism or the scale of the gradients does not capture them. In the future we will attempt to settle which alternative is more likely

A few of my favorite things: circumscribed interests in autism are not accompanied by increased attentional salience on a personalized selective attention task.

BACKGROUND: Autistic individuals commonly show circumscribed or "special" interests: areas of obsessive interest in a specific category. The present study investigated what impact these interests have on attention, an aspect of autistic cognition often reported as altered. In neurotypical individuals, interest and expertise have been shown to result in an automatic attentional priority for related items. Here, we examine whether this change in salience is also seen in autism. METHODS: Adolescents and young adults with and without autism performed a personalized selective attention task assessing the level of attentional priority afforded to images related to the participant's specific interests. In addition, participants performed a similar task with generic images in order to isolate any effects of interest and expertise. Crucially, all autistic and non-autistic individuals recruited for this study held a strong passion or interest. As such, any differences in attention could not be solely attributed to differing prevalence of interests in the two groups. In both tasks, participants were asked to perform a central target-detection task while ignoring irrelevant distractors (related or unrelated to their interests). The level of distractor interference under various task conditions was taken as an indication of attentional priority. RESULTS: Neurotypical individuals showed the predicted attentional priority for the circumscribed interest images but not generic items, reflecting the impact of their interest and expertise. Contrary to predictions, autistic individuals did not show this priority: processing the interest-related stimuli only when task demands were low. Attention to images unrelated to circumscribed interests was equivalent in the two groups. CONCLUSIONS: These results suggest that despite autistic individuals holding an intense interest in a particular class of stimuli, there may be a reduced impact of this prior experience and expertise on attentional processing. The implications of this absence of automatic priority are discussed in terms of the behaviors associated with the condition

Learning to work together: designing a multi-user virtual reality game for social collaboration and perspective-taking for children with autism

Children with Autism Spectrum Disorders (ASD) find it difficult to engage in reciprocal, shared behaviours and technology could be particularly helpful in supporting children’s motivations and skills in this area. Designing educational technologies for children with ASD requires the integration of a complex range of factors including pedagogical and cognitive theories; the affordances of the technology; and the real-world contexts of use. This paper illustrates how these factors informed the design of a novel collaborative virtual reality environment (CVE) for supporting communicative perspective-taking skills for high-functioning children with ASD. Findings from a small-scale study involving eight typically developing (TD) children (aged 8 years) and six children with ASD (verbal mental age 9 years) are also reported. Children with ASD were supported to be reciprocal and collaborative in their responses, suggesting that this CVE could form the basis for a useful technology-based educational intervention

Structure, ontogeny and evolution of the patellar tendon in emus (Dromaius novaehollandiae) and other palaeognath birds

The patella (kneecap) exhibits multiple evolutionary origins in birds, mammals, and lizards, and is thought to increase the mechanical advantage of the knee extensor muscles. Despite appreciable interest in the specialized anatomy and locomotion of palaeognathous birds (ratites and relatives), the structure, ontogeny and evolution of the patella in these species remains poorly characterized. Within Palaeognathae, the patella has been reported to be either present, absent, or fused with other bones, but it is unclear how much of this variation is real, erroneous or ontogenetic. Clarification of the patella’s form in palaeognaths would provide insight into the early evolution of the patella in birds, in addition to the specialized locomotion of these species. Findings would also provide new character data of use in resolving the controversial evolutionary relationships of palaeognaths. In this study, we examined the gross and histological anatomy of the emu patellar tendon across several age groups from five weeks to 18 months. We combined these results with our observations and those of others regarding the patella in palaeognaths and their outgroups (both extant and extinct), to reconstruct the evolution of the patella in birds. We found no evidence of an ossified patella in emus, but noted its tendon to have a highly unusual morphology comprising large volumes of adipose tissue contained within a collagenous meshwork. The emu patellar tendon also included increasing amounts of a cartilage-like tissue throughout ontogeny. We speculate that the unusual morphology of the patellar tendon in emus results from assimilation of a peri-articular fat pad, and metaplastic formation of cartilage, both potentially as adaptations to increasing tendon load. We corroborate previous observations of a ‘double patella’ in ostriches, but in contrast to some assertions, we find independent (i.e., unfused) ossified patellae in kiwis and tinamous. Our reconstructions suggest a single evolutionary origin of the patella in birds and that the ancestral patella is likely to have been a composite structure comprising a small ossified portion, lost by some species (e.g., emus, moa) but expanded in others (e.g., ostriches)

The Iowa Homemaker vol.33, no.4

An American Task, Dr. Paul Sharp, page 7 Pizza, Doris Jirsa, page 8 International Social Whirl, Ann Lindemeyer, page 9 Enchanting Paris, Else Nielsen, page 10 New Foods and Flavors, Dorothy Will, page 11 Costa Rican Friendships, Margaret Cole, page 12 A Debt Is Due, Marilyn Heu and Lillian Nakamota, page 13 Information Please, Rachel Bernau and Margaret Mattison, page 14 Overseas Jobs for YOU, Kay Scholten, page 15 Food for the Male, Pat Stiff, page 16 An Invitation to the U. N. Tea, Jane Hammerly, page 17 A.H.E.A. Ambassadors, Harriet Parsons, page 18 Nationally Speaking, Dorothy Will, page 19 What’s New, page 20 Trends, Gwen Owen, page 2

Internet-Based Photoaging Within Australian Pharmacies to Promote Smoking Cessation: Randomized Controlled Trial

Background: Tobacco smoking leads to death or disability and a drain on national resources. The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18-30 years are relatively resistant to antismoking messages due to their widely held belief that they will not be lifelong smokers. Objective: To conduct a randomized controlled trial (RCT) of a computer-generated photoaging intervention to promote smoking cessation among young adult smokers within a community pharmacy setting. Methods: A trial was designed with 80% power based on the effect size observed in a published pilot study; 160 subjects were recruited (80 allocated to the control group and 80 to the intervention group) from 8 metropolitan community pharmacies located around Perth city center in Western Australia. All participants received standardized smoking cessation advice. The intervention group participants were also digitally photoaged by using the Internet-based APRIL Face Aging software so they could preview images of themselves as a lifelong smoker and as a nonsmoker. Due to the nature of the intervention, the participants and researcher could not be blinded to the study. The main outcome measure was quit attempts at 6-month follow-up, both self-reported and biochemically validated through testing for carbon monoxide (CO), and nicotine dependence assessed via the Fagerström scale.Results: At 6-month follow-up, 5 of 80 control group participants (6.3%) suggested they had quit smoking, but only 1 of 80 control group participants (1.3%) consented to, and was confirmed by, CO validation. In the intervention group, 22 of 80 participants (27.5%) reported quitting, with 11 of 80 participants (13.8%) confirmed by CO testing. This difference in biochemically confirmed quit attempts was statistically significant (χ21=9.0, P=.003). A repeated measures analysis suggested the average intervention group smoking dependence score had also significantly dropped compared to control participants (P<.001). These differences remained statistically significant after adjustment for small differences in gender distribution and nicotine dependence between the groups. The mean cost of implementing the intervention was estimated at AU $5.79 per participant. The incremental cost-effectiveness ratio was AU$46 per additional quitter. The mean cost that participants indicated they were willing to pay for the digital aging service was AU $20.25 (SD 15.32). Conclusions: Demonstrating the detrimental effects on facial physical appearance by using a computer-generated simulation may be both effective and cost-effective at persuading young adult smokers to quit