Assessing the strength of directed influences among neural signals : An approach to noisy data

Acknowledgements This work was supported by the German Science Foundation (Ti315/4-2), the German Federal Ministry of Education and Research (BMBF grant 01GQ0420), and the Excellence Initiative of the German Federal and State Governments. B.S. is indebted to the Kosterlitz Centre for the financial support of this research project.Peer reviewedPreprin

Sequential Simulation (SqS): an empirical and theoretical model

Ethics statement: The authors declare that they have followed the guidelines for scientific integrity and professional ethics. The article does not contain any studies with human or animal subjects. Introduction & Aim: Stroke is one of the leading causes of morbidity and mortality worldwide. In eligible patients with acute ischemic stroke, early treatment with intravenous thrombolysis is crucial for a good patient outcome. We introduced simulation training sessions in conjunction with an improved treatment protocol as part of a quality improvement project to reduce door-to-needle times in stroke thrombolysis. Methods: A questionnaire assessing our preexisting treatment protocol was sent to all members of the stroke team. A panel of experts reviewed the responses and suggested potential changes to streamline the treatment protocol. In February 2017, we introduced the new protocol along with weekly videotaped in-situ scenario based simulation sessions with all stroke team members as participants. Previous stroke patients acted as markers. Kirkpatrick’s four-level training evaluation model was used for assessment. Here we present 1) Participant reactions (level 1) on a Likert item from 0-10, and 2) Median door-to-needle times in stroke thrombolysis, a measure of clinical behavioral change (level 3), using a statistical process control method. Simulated performance and long term patient outcomes will be assessed in future analysis. Results & Discussion: Participant reactions were predominantly positive. Self-perceived learning scored a median of 8 (IQR 7-9). We compared door-to-needle times for 478 prospectively included patients with acute ischemic stroke treated with intravenous thrombolysis at our hospital from January 2014 – July 2017. There was a significant reduction in median door-to-needle time from 27 (IQR 19-41) to 13 minutes (IQR 9-21, p<0.001) for the 78 patients in the post-intervention group. The results remained significant regardless of time of admission. There were no significant changes in the rate of stroke mimics, prehospital time or fatal intracranial hemorrhage. Simulation training in conjunction with protocol improvement led to an immediate and significant reduction of median door-to-needle time in stroke thrombolysis (Fig. 1). To our knowledge, no other published data have shown lower median treatment times. Combining simulation training with protocol change holds promise as a method both for effective implementation and significant results in attempts to reduce in-hospital delays in stroke thrombolysis. Effects on non-technical skills, provider variability and long term patient outcomes are yet to be evaluated

Effects of the Simulation Using Team Deliberate Practice (Sim-TDP) model on the performance of undergraduate nursing students

Background The use of simulation has grown in prominence, but variation in the quality of provision has been reported, leading to calls for further research into the most effective instructional designs. Simulation Using Team Deliberate Practice (Sim-TDP) was developed in response. It combines the principles of simulation with deliberate practice, therefore, providing participants with opportunities to work towards well-defined goals, rehearse skills and reflect on performance whilst receiving expert feedback. This study aimed to compare the effects of Sim-TDP, versus the use of traditional simulation, on the performance of second year adult nursing students. Methods Using a longitudinal quasi-experimental design, the effects of the two approaches were compared over a 1-year period. Sixteen groups, each containing an average of six participants, were randomised into an intervention arm (n=8) or comparison arm (n=8). Data collection took place at 3 monthly intervals, at which point the performance and time to complete the scenario objectives/tasks, as a team, were recorded and analysed using a validated performance tool. Results The independent t-tests, comparing the performance of the groups, did not demonstrate any notable differences during the three phases. However, in phase 1, the independent t-tests suggested an improvement in the Sim-TDP participants’ time spent on task (t (14) = 5.12, p<0.001), with a mean difference of 7.22 min. The mixed analysis of covariance inferred that the use of the Sim-TDP led to an improvement, over time, in the participants’ performance (F(1, 5) = 12.91, p=0.016), and thus, an association between Sim-TDP and the enhanced performance of participants. Conclusion The results suggest that Sim-TDP, potentially, optimised participant performance, while maximising the use of Simulation-based education (SBE) resources, such as simulation facilities and equipment. The model could be of practical benefit to nurse educators wishing to integrate SBE into their programmes

The KOALA-study: study protocol for a comprehensive study of cognitive biases in adolescent anorexia nervosa patients compared to healthy and clinical controls

BACKGROUND Anorexia nervosa (AN) is characterized by dysfunctional cognitions including cognitive biases at various levels of information processing. However, less is known about the specificity of these biases, i.e., if they occur for eating-disorder-related information alone or also for non-eating-disorder-related emotional information in AN patients (content-specificity) and if they are unique to individuals with AN or are also shown by individuals with other mental disorders (disorder-specificity). METHODS The present study systematically assesses cognitive biases in 12-18-year-old female adolescents with AN on three levels of information processing (attention, interpretation, and memory) and with regard to two types of information content (eating-disorder-related, i.e., stimuli related to body weight and shape, and non-eating-disorder-related). To address not only content- but also disorder-specificity, adolescents with AN will be compared not only to a healthy control group but also to a clinical control group (adolescents with major depression or particular anxiety disorders). Cognitive biases are assessed within a single experimental paradigm based on the Scrambled Sentences Task. During the task eye movements are recorded in order to assess attention biases while interpretation biases are derived from the behavioural outcome. An incidental free recall test afterwards assesses memory biases. We expect adolescents with AN to show more pronounced negative cognitive biases on all three levels of information processing and for both types of content compared to healthy adolescents. In addition, we expect the specificity of biases to translate into differential results for the two types of content: AN patients are expected to show stronger biases for disorder-related stimuli but similar or less pronounced biases for non-disorder-related stimuli compared to the clinical control group. DISCUSSION This is the first study to comprehensively assess cognitive biases in adolescents with AN. It will have essential implications not only for cognitive-behavioural models of AN but also for subsequent studies aiming to modify cognitive biases in this population, thereby addressing important maintaining factors already at an early stage of the disorder

Stop smoking service clients' views following the introduction of smoke-free legislation in England

This study aimed to explore smoker's perspectives of continued smoking and smoking cessation following the introduction of smoke-free legislation in England. Seventeen semi-structured interviews were conducted with smokers who were making a quit attempt with the support of stop smoking services delivered by the National Health Service. Interviews explored opinions of smoke-free legislation before it was implemented in July 2007, as well as attitudes towards the legislation, beliefs about the influence of legislation on smoking behaviours, as well as changes to public attitudes about smoking. Framework analysis highlighted five key themes: attitudes towards smoke-free legislation prior to its introduction, support for smoke-free legislation following implementation, smoke-free legislation and smoking behaviour, stigma, and returning to smoking. Overall, smokers were positive about smoke-free legislation and reported reductions in smoking and an increase in quit attempts after introduction of the legislation. Change in attitudes towards smoking and smokers were noted, which at times could transpire to stigmatisation felt by the participants. Few quitters expressed a wish to return to smoking if the legislation was reversed

Look me in the eyes! A preliminary study on eye‐contact in adolescents with anorexia nervosa

Objective Anorexia nervosa (AN) is often associated with impairments in the socio-emotional domain. Avoidance of eye-contact may underlie some of these difficulties and has been found in adults with AN in several studies. This study aimed to clarify whether adolescents with AN also show reduced eye-contact when viewing social stimuli, that is, faces. Methods In this cross-sectional study, girls aged 12–18 years with AN (n = 38) were compared with a clinical (girls with depression and/or anxiety disorders; n = 30) and a healthy (n = 36) control group. Eye-contact was operationalised as maintenance of visual attention to the eye-area of faces showing different emotional expressions (happy, angry, afraid, sad, neutral), recorded via eye-tracking. Results Contrary to our expectations, we did not find adolescents with AN to dwell less on the eye-area than control groups; instead, we found preliminary evidence for increased attention to the eye-area in the AN group compared to the healthy control group. Conclusions The results suggest that reduced eye-contact found in adult AN samples is not (yet) present in adolescents with AN but may develop with the prolonged duration of the disorder. However, replication and longitudinal studies are needed to confirm this assumption

Detection of time-, frequency- and direction-resolved communication within brain networks

This work was in part supported by a grant from the Macdonald Trust to BP and BS, and by a grant from the Alzheimer Society (AS-PG-14-039) to BP and GR.Peer reviewedPublisher PD

Effects of a tropical cyclone on salt marsh insect communities and post-cyclone reassembly processes

© 2020 The Authors. Ecography published by John Wiley & Sons Ltd on behalf of Nordic Society Oikos Concepts regarding effects of recurrent natural disturbances and subsequent responses of communities are central to ecology and conservation biology. Tropical cyclones constitute major disturbances producing direct effects (damage, mortality) in many coastal communities worldwide. Subsequent reassembly involves changes in composition and abundance for which the underlying mechanisms (deterministic and stochastic processes) are still not clear, especially for mobile organisms. We examined tropical cyclone-induced changes in composition and reassembly of entire insect communities in 16 Louisiana coastal salt marshes before and after Hurricane Isaac in 2012 and 2013. We used the Shannon index and multivariate permutational ANOVA to study insect resistance and resilience, β diversity partitioning to evaluate the importance of species replacement, and null models to disentangle the relative roles of different assembly processes over time after the tropical cyclone. The α diversity and species composition, overall and for different trophic levels, decreased immediately after the tropical cyclone; nonetheless, both then increased rapidly and returned to pre-cyclone states within one year. Changes in species abundance, rather than species replacement, was the primary driver, accounting for most temporal dissimilarity among insect communities. Stochastic processes, which drove community composition immediately after the tropical cyclone, decreased in importance over time. Our study indicates that rapid reformation of insect communities involved sequential landscape-level dynamics. Cyclone-resistant life cycle stages apparently survived in some, perhaps random locations within the overall salt marsh landscape. Subsequently, stochastic patterns of immigration of mobile life cycle stages resulted in rapid reformation of local communities. Post-cyclone direct regeneration of salt marsh insect communities resulted from low resistance, coupled with high landscape-level resilience via re-immigration. Our study suggests that the extent of direct regeneration of local salt marsh insect communities might change with the size of larger marsh landscapes within which they are imbedded

Evaluation of a flipped classroom approach to learning introductory epidemiology

Background Although the flipped classroom model has been widely adopted in medical education, reports on its use in graduate-level public health programs are limited. This study describes the design, implementation, and evaluation of a flipped classroom redesign of an introductory epidemiology course and compares it to a traditional model. Methods One hundred fifty Masters-level students enrolled in an introductory epidemiology course with a traditional format (in-person lecture and discussion section, at-home assignment; 2015, N = 72) and a flipped classroom format (at-home lecture, in-person discussion section and assignment; 2016, N = 78). Using mixed methods, we compared student characteristics, examination scores, and end-of-course evaluations of the 2016 flipped classroom format and the 2015 traditional format. Data on the flipped classroom format, including pre- and post-course surveys, open-ended questions, self-reports of section leader teaching practices, and classroom observations, were evaluated. Results There were no statistically significant differences in examination scores or students’ assessment of the course between 2015 (traditional) and 2016 (flipped). In 2016, 57.1% (36) of respondents to the end-of-course evaluation found watching video lectures at home to have a positive impact on their time management. Open-ended survey responses indicated a number of strengths of the flipped classroom approach, including the freedom to watch pre-recorded lectures at any time and the ability of section leaders to clarify targeted concepts. Suggestions for improvement focused on ways to increase regular interaction with lecturers. Conclusions There was no significant difference in students’ performance on quantitative assessments comparing the traditional format to the flipped classroom format. The flipped format did allow for greater flexibility and applied learning opportunities at home and during discussion sections

Curable sexually transmitted infections among women with HIV in sub-Saharan Africa

OBJECTIVES: Sexually transmitted infections (STIs) cause significant morbidity among women with HIV and increase HIV transmission. We estimated the prevalence of four STIs among women with HIV in sub-Saharan Africa (SSA) and compared prevalence among women with and without HIV. DESIGN: Systematic review and meta-analysis. METHODS: We searched for studies published 1 January 1999 to 19 December 2019 reporting prevalence of gonorrhea, chlamydia, trichomoniasis, or Mycoplasma genitalium among women with HIV in SSA. We excluded studies conducted in high-risk groups (e.g. female sex workers). We extracted data on laboratory-confirmed STIs among women with HIV, and when included, among women without HIV. We estimated pooled prevalence for each STI among women with HIV using inverse variance heterogeneity meta-analysis, compared prevalence to women without HIV, and examined the influences of region, clinical setting, and pregnancy status in subgroup analyses. RESULTS: We identified 3756 unique records; 67 studies were included in the meta-analysis. Prevalence of gonorrhea, chlamydia, trichomoniasis, and M. genitalium was 3.5, 4, 15.6, and 10.2%, respectively. Chlamydia prevalence was lower in Eastern (2.8%) than in Southern (12.5%) and West/Central (19.1%) Africa combined. Prevalence of chlamydia and trichomoniasis was higher among pregnant (8.1%, 17.6%) than nonpregnant (1.7%, 12.3%) women. All STIs were more prevalent among women with than without HIV (relative risks ranging 1.54-1.89). CONCLUSION: STIs are common among women with HIV in SSA, and more common among women with than without HIV. Integrated STI and HIV care could substantially impact STI burden among women with HIV, with potential downstream impacts on HIV transmission