Rheumatologists' judgements about the efficacy of anti-TNF therapy in two neighbouring regions

Objectives: The requirement in Northern Ireland to prescribe biologic agents according to NICE/BSR guidelines and within a fixed budget has created a waiting list for treatment that has no parallel in the Republic of Ireland. The study investigated the bearing this situation may have on had on the consultants’ judgements in the respective areas.

Methods: 78 case vignettes created from the data on real patients with RA treated with biologics in the north and south of Ireland were appraised by 9 southern and 8 northern consultants who judged the clinical benefit and significance of the patients’ condition after a trial of therapy. Quantitative (Clinical Judgement Analysis) and Qualitative (Focus groups) techniques were used.

Results: Northern consultants perceived a slightly greater degree of clinical benefit after a trial of therapy than southern consultants. Judgment models of northern and southern consultants were broadly comparable. The latter tended to be more uniform in their judgments than the southern group. Focus group discussions with consultants largely validated the findings of the quantitative analysis but revealed how clinical judgment analysis might be misled by gaming strategies.

Conclusions: Despite the absence of overt rationing in the south of Ireland, as far as the judgment of therapeutic benefit from biologics was concerned, the clinical judgment policies of practitioners were very similar to those in the north. The adoption of NICE/BSR guidelines in the north may have improved the uniformity of clinical practice in Northern Ireland.

Children's judgements about pain at age 8-10 years:do extremely low birthweight (<or = 1000 g) children differ from full birthweight peers?

Children's judgements about pain at age 8-10 years were examined comparing two groups of children who had experienced different exposure to nociceptive procedures in the neonatal period: extremely low birthweight (ELBW) <or = 1000 g (N = 47) and full birthweight (FBW) > or = 2500 g (N = 37). The 24 pictures that comprise the Pediatric Pain Inventory, depicting events in four settings: medical, recreational, daily living, and psychosocial, were used as the pain stimuli. The subjects rated pain intensity using the Color Analog Scale and pain affect using the Facial Affective Scale. Child IQ and maternal education were statistically adjusted in group comparisons. Pain intensity and pain affect related to activities of daily living and recreation were significantly higher than psychosocial and medically related pain on both scales in both groups of children. Although the two groups of children did not differ overall in their perceptions of pain intensity or affect, the ELBW children rated medical pain intensity significantly higher than psychosocial pain, unlike the FBW group. Also, duration of neonatal intensive care unit stay for the ELBW children was related to increased pain affect ratings in recreational and daily living settings. Despite altered response to pain in the early years reported by parents, on the whole at 8-10 years of age ELBW children judged pain in pictures similarly to their term peers. However, differences were evident, which suggests that studies are needed of biobehavioural reactivity to pain beyond infancy, as well as research into beliefs, attitudes, and perceptions about pain during the course of childhood in formerly ELBW children.

Judging Time Intevals using a model of perceptuo-motor control

Estimating a time interval and temporally coordinating movements in space are fundamental skills, but the relationships between these different forms of timing, and the neural processes that they incur, are not well understood. While different theories have been proposed to account for time perception, time estimation, and the temporal patterns of coordination, there are no general mechanisms which unify these various timing skills. This study considers whether a model of perceptuo-motor timing, the tau(GUIDE), can also describe how certain judgements of elapsed time are made. To evaluate this, an equation for determining interval estimates was derived from the tau(GUIDE) model and tested in a task where participants had to throw a ball and estimate when it would hit the floor. The results showed that in accordance with the model, very accurate judgements could be made without vision (mean timing error -19.24 msec), and the model was a good predictor of skilled participants' estimate timing. It was concluded that since the tau(GUIDE) principle provides temporal information in a generic form, it could be a unitary process that links different forms of timing.

Temporal information and children's and adults' causal inferences

Three experiments examined whether children and adults would use temporal information as a cue to the causal structure of a three-variable system, and also whether their judgements about the effects of interventions on the system would be affected by the temporal properties of the event sequence. Participants were shown a system in which two events B and C occurred either simultaneously (synchronous condition) or in a temporal sequence (sequential condition) following an initial event A. The causal judgements of adults and 6-7-year-olds differed between the conditions, but this was not the case for 4-year-olds' judgements. However, unlike those of adults, 6-7-year-olds' intervention judgements were not affected by condition, and causal and intervention judgements were not reliably consistent in this age group. The findings support the claim that temporal information provides an important cue to causal structure, at least in older children. However, they raise important issues about the relationship between causal and intervention judgements.

Using time-to-contact information to assess potential collision modulates both visual and temporal prediction networks

Accurate estimates of the time-to-contact (TTC) of approaching objects are crucial for survival. We used an ecologically valid driving simulation to compare and contrast the neural substrates of egocentric (head-on approach) and allocentric (lateral approach) TTC tasks in a fully factorial, event-related fMRI design. Compared to colour control tasks, both egocentric and allocentric TTC tasks activated left ventral premotor cortex/frontal operculum and inferior parietal cortex, the same areas that have previously been implicated in temporal attentional orienting. Despite differences in visual and cognitive demands, both TTC and temporal orienting paradigms encourage the use of temporally predictive information to guide behaviour, suggesting these areas may form a core network for temporal prediction. We also demonstrated that the temporal derivative of the perceptual index tau (tau-dot) held predictive value for making collision judgements and varied inversely with activity in primary visual cortex (V1). Specifically, V1 activity increased with the increasing likelihood of reporting a collision, suggesting top-down attentional modulation of early visual processing areas as a function of subjective collision. Finally, egocentric viewpoints provoked a response bias for reporting collisions, rather than no-collisions, reflecting increased caution for head-on approaches. Associated increases in SMA activity suggest motor preparation mechanisms were engaged, despite the perceptual nature of the task.

Background beliefs and evidence interpretation

In this paper we argue that it is often adaptive to use one’s background beliefs when interpreting information that, from a normative point of view, is incomplete. In both of the experiments reported here participants were presented with an item possessing two features and were asked to judge, in the light of some evidence concerning the features, to which of two categories it was more likely that the item belonged. It was found that when participants received evidence relevant to just one of these hypothesised categories (i.e. evidence that did not form a Bayesian likelihood ratio) they used their background beliefs to interpret this information. In Experiment 2, on the other hand, participants behaved in a broadly Bayesian manner when the evidence they received constituted a completed likelihood ratio. We discuss the circumstances under which participants, when making their judgements, consider the alternative hypothesis. We conclude with a discussion of the implications of our results for an understanding of hypothesis testing, belief revision, and categorisation.

How information guides movement: Intercepting curved free kicks in soccer

Previous studies have shown that balls subjected to spin induce large errors in perceptual judgements (Craig et al, 2006; Craig et al 2009) due to the additional accelerative force that causes the ball’s flight path to deviate from a standard parabolic trajectory. A recent review however, has suggested that the findings from such experiments may be imprecise due to the decoupling of perception and action and the reliance on the ventral system (Van der Kamp et al, 2008). The aim of this study was to present the same curved free kick trajectory simulations from the perception only studies (Craig et al, 2006; Craig et al, 2009) but this time allow participants to move to intercept the ball. By using immersive, interactive virtual reality technology participants were asked to control the movement of a virtual effector presented in a virtual soccer stadium so that it would make contact with a virtual soccer ball as it crossed the goal-line. As in the perception only studies the direction of spin had a significant effect on the participants’ responses (F(2,12)=222.340; p

A comparative study of nursing attitudes towards young male survivors of brain injury: A questionnaire survey.

Background The attitudes members of the nursing profession hold towards survivors of brain injury may impact on the level of help, and degree of involvement they are willing to have. Given that the manner in which an individual receives their brain injury has been shown to impact on public prejudices, the importance of exploring nursing attitudes to this vulnerable group, and the subsequent impact this may have on the caring role, requires investigation. Objective To investigate the attitudes held by members of the nursing profession towards young male survivors of brain injury whose behaviour either contributed, or did not contribute, to their injury. Design Independent groups design. Setting and participants Ninety trainee and sixty-nine qualified nurses respectively drawn from a university in the south west of England and the emergency, orthopaedic and paediatric Departments of the Royal Devon and Exeter Hospital, UK. Methods Participants were randomly assigned to one of four fictional brain injury scenarios. A young male character was portrayed as sustaining a brain injury as a result of either an aneurysm, or through drug taking, with their behaviour being either a contributory or non-contributory factor. On reading these, participants were asked to complete the prejudicial evaluation scale, the social interaction scale and the helping behaviour scale. Results Analysis of variance showed that qualified nurses held more prejudicial attitudes than student nurses towards survivors of brain injury. Mean scores indicated that individuals seen as contributing towards their injury were likely to experience more prejudice (blame total = 42.35 vs. no blame total = 38.34), less social interaction (blame total = 37.54 vs. no blame total = 41.10), and less helping behaviour (blame total = 21.49 vs. no blame total = 22.34) by both groups. Conclusions Qualified nurses should be mindful of the impact their attitudes and judgements of survivors of brain injury may have on the subsequent care they provide. Greater emphasis on the effects of negative attitudes on patient interactions during training may provide nurses with the understanding to recognise and avoid challenges to their caring role in the future.

Article 260(2) TFEU: An Effective Judicial Procedure for the Enforcement of Judgments?

Article 260(2) TFEU (ex 228(2) EC) enables the European Court of Justice to enforce compliance with its judgements. This article analyses its use in doing so and questions whether it could be applied more effectively. It commences by highlighting the principally economic and environmental context of the case-law, and by examining the initiatives taken to tackle delays in bringing these cases before the Court. The article then critically evaluates the effectiveness of the financial sanctions available to the Court. In doing so, it aims to fill a gap in present research by looking beyond the procedural measures through which the Court and the Commission operate to examine the practical impact of Article 260(2) itself.

From imagery to intention: A dual route model of imagined contact effects

Imagined intergroup contact (Crisp & R. Turner, 2009) is a new indirect contact strategy for promoting tolerance and more positive intergroup relations. In this chapter, we review existing research on imagined contact and propose two routes-cognitive and affective-through which it can exert a positive influence on contact-related attitudes and intentions. We first review research that has established the beneficial impacts of imagined contact on intergroup attitudes via reduced intergroup anxiety, supporting its efficacy as an intervention where there exists little or no opportunity for direct contact. We then review more recent research showing that imagined contact not only improves attitudes, but can also enhance intentions to engage in future contact. These studies suggest that contact imagery provides a behavioural script that forms the cognitive basis for subsequent judgements about future contact intentions. Collectively, the findings from this research programme support the idea that imagined contact can complement more direct forms of contact-providing a way of initially encouraging an interest in engaging positively with outgroups before introducing face-to-face encounters. We discuss the implications of these findings for future theory and research, and how they can inform prejudice-reduction interventions seeking to capitalise on the beneficial effects of mental imagery.

The role of formal structure in liking for popular music

The effect of restructuring the form of three unfamiliar pop/rock songs was investigated in two experiments. In the first experiment, listeners' judgements of the likely location of sections of novel popular songs were explored by requiring participants to place the eight sections (Intro - Verse 1 - Chorus 1 - Verse 2 - Chorus 2 - Bridge (solo) - Chorus 3 - Extro) of the songs into the locations they thought them most likely to occur within the song. Results revealed that participants were able to place the sections in approximately the right location with some accuracy, though they were unable to differentiate between choruses. In Experiment 2, three versions of each of the songs were presented in three different structures: intact (original form), medium restructured (the sections in a moderately changed order), and highly restructured (more severe restructuring). The results show that listeners' judgments of predictability and liking were largely uninfluenced by the restructuring of the songs, in line with findings for classical music. Moment-by-moment liking judgements of the songs demonstrated a change in liking judgements with repeated exposure, though the trend was downwards with repeated exposure rather than upwards. Detailed analysis of moment-by-moment judgements at the ends and beginnings of sections showed that listeners were able to respond quickly to intact songs, but not to restructured songs. The results suggest that concatenism prevails in listening to popular song at the expense of paying attention to larger structural features. © 2012 by the regents of the university of california all rights reserved.

Judging pain in infants:behavioural, contextual, and developmental determinants

Caretakers intuitively use various sources of evidence when judging infant pain, but the relative importance of salient cues has received little attention. This investigation examined the predictive significance for judgements of painful discomfort in preterm and full-term neonates of behavioural (facial activity and body movement), contextual (invasiveness of the procedure), and developmental (gestational age) information. Judges viewed videotapes showing infants varying in the foregoing characteristics undergoing heel incisions for routine blood sampling purposes. Findings indicated all but the contextual information contributed uniquely to judgements of pain, with facial activity accounting for the most unique variance (35%), followed by bodily activity and gestational age, each accounting for 3% and 1% of the judgmental variance, respectively. Generally, 71% of the variance in ratings of pain could be predicted using facial activity alone, compared to 30% of the variance using bodily activity alone, 19% by relying on context alone, and 8% by referring to gestational age alone. Noteworthy was the tendency to judge early preterm infants to be experiencing less pain even though they were subjected to the same invasive procedure as the older infants. This finding also runs counter to evidence from developmental neurobiology which indicates that preterm newborns may be hypersensitive to invasive procedures.

Statistically-constrained shallow text marking:Techniques, evaluation paradigm and results

We present three natural language marking strategies based on fast and reliable shallow parsing techniques, and on widely available lexical resources: lexical substitution, adjective conjunction swaps, and relativiser switching. We test these techniques on a random sample of the British National Corpus. Individual candidate marks are checked for goodness of structural and semantic fit, using both lexical resources, and the web as a corpus. A representative sample of marks is given to 25 human judges to evaluate for acceptability and preservation of meaning. This establishes a correlation between corpus based felicity measures and perceived quality, and makes qualified predictions. Grammatical acceptability correlates with our automatic measure strongly (Pearson's r = 0.795, p = 0.001), allowing us to account for about two thirds of variability in human judgements. A moderate but statistically insignificant (Pearson's r = 0.422, p = 0.356) correlation is found with judgements of meaning preservation, indicating that the contextual window of five content words used for our automatic measure may need to be extended. © 2007 SPIE-IS&T.

Examining the Spectator Experience

Drawing on a model of spectator understanding of error in
performance in the literature, we document a qualitative
experiment that explores the relationships between domain
knowledge, mental models, intention and error recognition
by spectators of performances with electronic instruments.
Participants saw two performances with contrasting instruments,
with controls on their mental model and understanding
of intention. Based on data from a subsequent structured
interview, we identify themes in participants’ judgements
and understanding of performance and explanations
of their spectator experience. These reveal both elements
of similarity and difference between the two performances,
instruments and between domain knowledge groups. From
these, we suggest and discuss implications for the design of
novel performative interactions with technology