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As the use of guided digitally-delivered cognitive-behavioral therapy (GdCBT) grows, pragmatic analytic tools are needed to evaluate coaches’ implementation fidelity.
Aims
We evaluated how natural language processing (NLP) and machine learning (ML) methods might automate the monitoring of coaches’ implementation fidelity to GdCBT delivered as part of a randomized controlled trial.
Method
Coaches served as guides to 6-month GdCBT with 3,381 assigned users with or at risk for anxiety, depression, or eating disorders. CBT-trained and supervised human coders used a rubric to rate the implementation fidelity of 13,529 coach-to-user messages. NLP methods abstracted data from text-based coach-to-user messages, and 11 ML models predicting coach implementation fidelity were evaluated.
Results
Inter-rater agreement by human coders was excellent (intra-class correlation coefficient = .980–.992). Coaches achieved behavioral targets at the start of the GdCBT and maintained strong fidelity throughout most subsequent messages. Coaches also avoided prohibited actions (e.g. reinforcing users’ avoidance). Sentiment analyses generally indicated a higher frequency of coach-delivered positive than negative sentiment words and predicted coach implementation fidelity with acceptable performance metrics (e.g. area under the receiver operating characteristic curve [AUC] = 74.48%). The final best-performing ML algorithms that included a more comprehensive set of NLP features performed well (e.g. AUC = 76.06%).
Conclusions
NLP and ML tools could help clinical supervisors automate monitoring of coaches’ implementation fidelity to GdCBT. These tools could maximize allocation of scarce resources by reducing the personnel time needed to measure fidelity, potentially freeing up more time for high-quality clinical care.
Franco Basaglia (1924–1980) has a particular relevance to psychiatry today as he combined social critique with psychiatric reform. In the new ‘metacommunity’ era in psychiatry, his radical and critical thinking provides important tools, as does his enduring message that ‘freedom is (still today) therapeutic’.
The COVID-19 pandemic challenged older adults’ health behaviours, making it even more difficult to engage in healthy diets and physical activity than it had been prepandemic. A resource to promote these could be social support. This study uses data from 136 older adults (Mage = 71.39 years, SD = 5.15, range: 63–87) who reported their daily fruit and vegetable consumption, steps, and health-behaviour-specific support from a close other every evening for up to 10 consecutive days. Findings show that on days when participants reported more emotional support than usual, fruit and vegetable consumption and step counts were higher. Daily instrumental support was positively associated with step counts, only. Participants receiving more overall emotional support across the study period consumed more fruit and vegetables; no parallel person-level association was found for overall steps. There were no significant interactions between dyad type and support links for our outcomes.
In this study, we use an integrative taxonomic approach to redescribe Schyzocotyle nayarensis (Malhotra, 1983) (Cestoda: Bothriocephalidae), based on newly collected specimens from the type-host Raiamas bola (Hamilton, 1822) (Cypriniformes: Danionidae) in Fulbari, Siliguri, West Bengal, India. The detailed morphological assessment, from whole mounts, histology and scanning electron microscopy, offers additional insights into the scolex structure, vitelline follicles, and egg morphology. Molecular data from this and previous studies corroborate the identity and systematics of S. nayarensis as a bothriocephalid closely related to the Asian Fish Tapeworm, Schyzocotyle acheilognathi (Yamaguti, 1934). This study elucidates the historical context and taxonomic ambiguities surrounding S. nayarensis, emphasizing the key role of the scolex in both generic and species identification. Amendments to the diagnosis of Schyzocotyle Akhmerov, 1960 are proposed. A differential diagnosis of the two valid species within the genus, namely S. acheilognathi and S. nayarensis, is also provided. An evaluation of the taxonomic status of Bothriocephalus teleostei Malhotra, 1984, and Capooria barilii Malhotra, 1985 suggests that they may be S. nayarensis. Finally, we posit that none of the ten species of Ptychobothrium Lönnberg, 1889 described from Indian freshwater teleosts belong to this genus but instead appear to be a mix of species belonging to Schyzocotyle, Senga Dollfus, 1934, and possibly even Proteocephalidae La Rue, 1911; all require further study based on newly collected, properly fixed specimens and an integrated taxonomic approach. Finally, future survey studies may reveal hidden diversity of Schyzocotyle species in Indian cyprinoids.
Debate surrounds the early peopling of the Arabian Peninsula. The first evidence of the Levallois lithic technology in the Huqf area of south-eastern Arabia now extends the Middle Palaeolithic record of hominin activity into central Oman and helps to diversify the picture of Arabian prehistory.
Background: The use of patient reported and functional outcome measures in routine practice enhances shared decision making and supports patient-centred care. This study compared the perspectives of Chronic Inflammatory Neuropathy (CIN) patients and providers regarding their experience using an outcome measure panel. Methods: A one year study was conducted to evaluate a nine measure outcome set in routine clinical practice for CIN. The panel included patient-reported outcome measures (e.g., I-RODS and EQ-5D-5L) and functional measures (e.g., grip strength). At the conclusion of the study, participants and providers completed an online questionnaire on their experience. Results: 25 patients and five providers completed the questionnaire. Both patients and providers reported benefit in tracking disease progression, supporting treatment-related decisions, and broadening views of health. Both groups agreed patient involvement in care was enhanced. Preference for specific measures, frequency, and data presentation differed. Providers emphasized integration into electronic medical records and streamlining processes. 100% of providers and 80% of patients wanted to continue completing outcome measures. Conclusions: CIN patients and providers recognize the value of integrating outcome measures into routine care. To effectively implement these measures in clinical settings, it is important to understand the patient and provider perspective and prevent unnecessary burdens to ensure sustainability of use.
In his important discussion of Chaucer's Criseyde in Reform and Cultural Revolution, James Simpson offers the aside that provides my title quotation. “However painful it finally turns out to be,” he observes, Troilus possesses a freedom profoundly different from the circumstances that constrain Criseyde. Contrasting Troilus's immediate vision of love with her painful decision-making, he establishes the former's comparative social freedom as a foil to his real focus: the intense psychological narrative of Criseyde's “shrewd appraisal of the conditions in which she finds herself.” I will return to James's account of Criseyde shortly; but despite its brevity, I want to engage with this comment on Troilus's limited and painful freedom, and with James's work elsewhere on the concept of recognition, to propose this observation as a rather unexpected departure point: toward a theory of human love, and a changed understanding of tragedy. By a “theory of human love,” I mean the model of a freely willed, mutually self-constituting bond between individual, non-substitutable human beings; and when I say “toward,” I mean to suggest that lacking such a culturally sanctioned model, Chaucer responded to human reality with a radical experiment. That experiment, rooted in the freedom of the will and the ethical necessity of recognition, performed an act of transformation upon his sources: and so he also, I will argue, created a new form of tragedy.
There were of course many culturally sanctioned theories of love in the Middle Ages. Perfect divine love was idealized for humanity as universal caritas for God and neighbour; Aristotle's highest form of love between persons, philia, a relation between “men who are good, and alike in virtue,” had with Aquinas been Christianized as the necessary inclination of the soul toward the good, a participant in the greater love that leads to God. Responding to Cicero's classic treatise on friendship, Aelred of Rievaulx's On Spiritual Friendship defined love as “quidam animae rationalis affectus” (“a particular affection of the rational soul”), which in its highest form (“spiritual” as opposed to “carnal” and “worldly”) “inter bonos vitae, morum studiorumque similitudo conglutinat” (“is cemented between the good by similitude of life, morals and pursuits”).
Understanding historical environmental determinants associated with the risk of elevated marine water contamination could enhance monitoring marine beaches in a Canadian setting, which can also inform predictive marine water quality models and ongoing climate change preparedness efforts. This study aimed to assess the combination of environmental factors that best predicts Escherichia coli (E. coli) concentration at public beaches in Metro Vancouver, British Columbia, by combining the region’s microbial water quality data and publicly available environmental data from 2013 to 2021. We developed a Bayesian log-normal mixed-effects regression model to evaluate predictors of geometric E. coli concentrations at 15 beaches in the Metro Vancouver Region. We identified that higher levels of geometric mean E. coli levels were predicted by higher previous sample day E. coli concentrations, higher rainfall in the preceding 48 h, and higher 24-h average air temperature at the median or higher levels of the 24-h mean ultraviolet (UV) index. In contrast, higher levels of mean salinity were predicted to result in lower levels of E. coli. Finally, we determined that the average effects of the predictors varied highly by beach. Our findings could form the basis for building real-time predictive marine water quality models to enable more timely beach management decision-making.
Annual volume on medieval textual cultures, engaging with intellectual and cultural pluralism in the Middle Ages, showcasing the best new work in this field.
This study investigated everyday associations between one key facet of mindfulness (allocating attention to the present moment) and pain. In Study 1, 89 community-dwelling adults (33–88 years; Mage = 68.6) who had experienced a stroke provided 14 daily end-of-day present-moment awareness and pain ratings. In Study 2, 100 adults (50–85 years; Mage = 67.0 years) provided momentary present-moment awareness and pain ratings three times daily for 10 days. Multi-level models showed that higher trait present-moment awareness was linked with lower overall pain (both studies). In Study 1, participants reported less pain on days on which they indicated higher present-moment awareness. In Study 2, only individuals with no post-secondary education reported less pain in moments when they indicated higher present-moment awareness. Findings add to previous research using global retrospective pain measures by showing that present-moment awareness might correlate with reduced pain experiences, assessed close in time to when they occur.
In the early weeks of the 2020 coronavirus (COVID-19) pandemic, the Fox News Channel advanced a skeptical narrative that downplayed the risks posed by the virus. We find that this narrative had significant consequences: in localities with higher Fox News viewership—exogenous due to random variation in channel positioning—people were less likely to adopt behaviors geared toward social distancing (e.g., staying at home) and consumed fewer goods in preparation (e.g., cleaning products, hand sanitizers, and masks). Using original survey data, we find that the effect of Fox News came not merely from its long-standing distrustful stance toward science, but also due to program-specific content that minimized the COVID-19 threat. Taken together, our results demonstrate the significant impact that misinformation in media coverage can exert on viewers’ beliefs and behavior, even in high-stakes situations.
Our aim was for 80% of new referrals for behaviours that challenge within Tower Hamlets Community Learning Disability service to have an MDT coordinated approach by July 2022. This followed concerns about disjointed care and long waits for therapeutic support when being referred between different MDT branches within the service having a negative impact on patient care.
Methods
An MDT project team was formed and weekly meetings were arranged. A driver diagram was created. Our primary outcome measure was determined: percentage of referred patients per week that had MDT coordinated assessments, with data being collected manually from electronic progress notes and MDT meeting minutes. Number of referrals per week was recorded as a process measure. Baseline data were added to the Life QI web platform upon collection, allowing generation of run charts for outcome and process measures. The time-frame over which referrals were recorded was changed from weekly to fortnightly, to help differentiate graphically between zero values resulting from the absence of MDT coordination and those resulting from no referrals being received on a given week. Attempts were made to obtain service user input via easy-read questionnaires and subsequent discussion in a service user participation group. A weekly Positive Behavioural Support meeting was set up and a Positive Behavioural Support database was established, and the combination of these changes simplified data collection and gave a focus to MDT working and collaboration for these service users. Data were recorded from 28/06/2021 to 03/07/2022 initially and subsequently extended to 06/11/2022 as part of a further PDSA cycle.
Results
A shift in proportion of service users referred with behaviour that challenges who had MDT involvement at the point of allocation was observed, to above the mean value of 0.5, commencing 07/02/2022, this shift was sustained until the project's endpoint. In terms of our process measure, the median number of new behaviour that challenges referrals per fortnightly period to psychiatry and psychology was one. This ranged from 0-4 referrals per fortnightly period, but no sustained change in this value was observed over the course of the project.
Conclusion
Implementing a new behaviour that challenges database and weekly meeting to focus on MDT coordinated working in those newly referred with behaviour that challenges has been successful in leading to a measurable and sustained improvement in the proportion of those service users receiving timely MDT coordinated care.