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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.
Distressing mental images are common in people with psychosis. The central role of metacognitive difficulties in psychosis suggests that metacognitive interventions with imagery properties could play a central role in managing distressing mental imagery. A brief imagery-based metacognitive intervention was developed to target the control mechanism of distressing mental images in psychosis.
Aims:
A fixed baseline case series was designed to investigate whether the intervention was acceptable, feasible and effective.
Method:
Eight participants who met criteria for a schizophrenia spectrum diagnosis and experienced distressing future-oriented mental images took part in the case series, which consisted of three phases; baseline, intervention, and follow-up. Symptoms of anxiety, depression, persecutory delusions and schemas were assessed pre- and post-intervention, and qualitative feedback was collected at follow-up.
Results:
The metacognitive intervention was feasible, acceptable, and rated as highly satisfactory. One participant dropped out at the baseline phase. No adverse events were reported. Positive change scores with a decrease in symptoms were reported for anxiety, depression, persecutory delusions, and schemas. Tau-U analysis showed positive trends and high effect sizes on mental imagery characteristics at follow-up.
Conclusion:
Our findings suggest that it is acceptable and feasible to engage people with psychosis in a brief imagery-based metacognitive intervention and that positive change can be achieved. Further studies are needed to replicate and clarify the findings of our study and develop the evidence base for this intervention.
It is difficult to reconstruct and analyze the relationship between romances and their historical contexts, especially because of the power of modern myths about chivalry. There was no single age of chivalry that stretched from the eleventh or twelfth centuries to the fifteenth century and beyond, and there was no single code or ideal for how aristocrats should behave during that period. Societies and cultures inevitably changed over time, and there were important geographical variations across the different regions, lands, and linguistic contexts that today form Western Europe. Therefore, medieval romances must be considered against the specific historical contexts in which they were produced and read. This chapter focuses on examples and case studies drawn from fourteenth- and fifteenth-century France and England, a period that has often been dismissed as one of chivalric decline. Yet radical changes in warfare, aristocratic class, and identity, as well as lay literacy and engagement with book ownership and writing created a dynamic context for the production and consumption of chivalric texts of all kinds.
Tenancy in common, joint tenancy, and tenancy by the entireties are forms of co-ownership of property. Inter vivos transfers, testate transfers, and intestate transfers of property can create these types of concurrent ownership. When an estate in fee is transferred to a married couple, the two become concurrent owners. The question is what form of concurrent tenancy is created.
First full English translation of a major text, narrating the adventures of the Jouvencel whilst interweaving them with advice on military tactics and strategies.
On the 16 September 2017, thirty-three people gathered in the Huntingdon Room at the Centre for Medieval Studies in the University of York. Thirty-two of those people knew that the workshop entitled Political Culture in Late Medieval England was a celebration of the sixtieth birthday of Professor Mark Ormrod, the culmination of years of secret planning to bring together his doctoral students and the researchers who had assisted him on an array of funded projects. Nine of those individuals presented scholarly papers at the workshop, and then, once the academic portion of the day was complete, the audience viewed a series of congratulatory video messages from a number of Mark's friends and colleagues, before enjoying a grand celebratory feast.
This volume serves as a record of that event, bringing together papers presented at that workshop with additional pieces, all written by Mark Ormrod’s students and former research assistants. Since our primary aim in putting together this volume is to celebrate Mark's birthday and to highlight his outstanding contribution to the field through PhD supervision and research projects, we have chosen not to include a list of his extensive publications in this book: we anticipate that such a list will be forthcoming when Mark’s contribution to the discipline is further celebrated and recognised.
The volume reflects the vibrancy and range of the honorand's own illustrious research on the structures, personalities and culture of rulership of late medieval England. It encompasses political, administrative, Church and social history, focussing upon three main themes: monarchy, state and political culture. For the first, it explores the history of emotion by considering Edward III's reactions to the deaths of his kinfolk and close associates, emphasising the practicality of the king's responses. It also investigates cases of political defamation in the fourteenth century, highlighting how non-elite subjects engaged in discourse about kingship and monarchy. The workings of the ‘state’ are examined through studies of a Yorkshire tax collector caught in the act of defrauding the exchequer, of the function and jurisdiction of the Court of Chivalry in the late fourteenth century, of the power dynamics underpinning statute-making in the early fifteenth-century parliament, and of the working practices of the privy seal clerk, Thomas Hoccleve.
[145] At the beginning of the world, once God had created man and woman and provided them with all that they could desire, very soon thereafter His peace was broken and war – so contrary to all natural order – broke out between those natural allies and brothers, Cain and Abel. And as the second chapter of the book of Genesis explains, that war stemmed from envy. Genesis shows therefore how the birth of that dreadful scourge was occasioned and triggered and begun by a single person, and yet, over time, it spread prolifically, and multiplied as the generations grew and multiplied. And hence discord and dissension took hold in all parts of the world, and though it might seem to have disappeared in certain places, that is compensated for by renewed and prolonged war elsewhere, for war can take hold just as well between the worthy as between the wicked – and while we should stress that no-one is worthy if he declares war unprovoked, he cannot be condemned if he pursues war in defence of a rightful cause. It was for this reason that the most excellent and most noble order of knighthood was established, in order to protect, safeguard, and defend the common people who are always the most damaged by the perils of war. This means that all good and valiant knights, soldiers, and captains should rely for victory not only on strength [146] of numbers but also on subtlety and due prudence – which, as we read in much of the Bible and especially in the Book of Kings, were what allowed the Israelites to subjugate and subdue large numbers of Philistines and other aliens. What enabled the Israelites to do this was the sagacity and calculation of their commanders, and above all God's help – which should be cited first, for to Him all manner of men should address themselves.
My intention, with God's help, is to write a little treatise, in the form of a story, to inspire all men, and especially those who pursue the extraordinary adventures of a life of war, to seek always to do good and to enhance their fortitude.